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Predictors of Neurological Worsening after Resection of Spinal Meningiomas

SIMPLE SUMMARY: Despite the benign nature of these tumors, spinal meningiomas can cause significant neurological damage via compression of the spinal cord. In this study, we found that neurological function improves in a significant proportion of patients after surgery. Preoperative Frankel grade wa...

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Autores principales: Jankovic, Dragan, Kalasauskas, Darius, Othman, Ahmed, Brockmann, Marc A., Sommer, Clemens J., Ringel, Florian, Keric, Naureen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10670172/
https://www.ncbi.nlm.nih.gov/pubmed/38001667
http://dx.doi.org/10.3390/cancers15225408
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author Jankovic, Dragan
Kalasauskas, Darius
Othman, Ahmed
Brockmann, Marc A.
Sommer, Clemens J.
Ringel, Florian
Keric, Naureen
author_facet Jankovic, Dragan
Kalasauskas, Darius
Othman, Ahmed
Brockmann, Marc A.
Sommer, Clemens J.
Ringel, Florian
Keric, Naureen
author_sort Jankovic, Dragan
collection PubMed
description SIMPLE SUMMARY: Despite the benign nature of these tumors, spinal meningiomas can cause significant neurological damage via compression of the spinal cord. In this study, we found that neurological function improves in a significant proportion of patients after surgery. Preoperative Frankel grade was a significant predictor of postoperative neurological worsening. Cross-section area measurements on MRI scans are not associated with early postoperative outcomes. ABSTRACT: Background: Due to the slow-growing nature of spinal meningiomas, they are mostly asymptomatic for a long time, and become symptomatic after the compression of the spinal cord or nerve roots. The aim of this study was to identify predictors for a poor clinical outcome after the surgical resection of spinal meningiomas and thereby to allow a preoperative identification of high-risk spinal meningiomas. Methods: Data acquisition was conducted as a single-center retrospective analysis. From 1 January 2004 to 31 December 2019, 121 patients who underwent surgical resection of a spinal meningioma were reviewed. Clinical and radiological data (such as tumor size, location, occupation ratio of the spinal canal, and the degree of spinal cord compression) were assessed. The functional clinical findings of the patients were recorded using the Karnofsky Performance Score, modified McCormick scale, and Frankel scale preoperatively, at discharge, and 3–6 months after surgery. Results: The mean patient age was 66 ± 13 years. A total of 104 (86%) patients were female and 17 (14%) were male. The thoracic spine (68%) was the most common location, followed by the cervical (29%) and lumbar (3%) spine. Preoperatively, 11.7% of patients were categorized as McCormick 1, 35.8% as 2, 39.2% as 3, 11.7% as 4, and 1.7% as 5. The neurological function of the patients with a functional deficit prior to surgery improved in 46% of the patients, remained unchanged in 52%, and worsened in 2% at discharge. At early follow-up, the proportions were 54%, 28%, and 5%, respectively. Preoperative Frankel scale was a significant predictor of a postoperative deterioration. Patients with Frankel score A to C preoperatively had a 9.2 times higher chance of clinical deterioration postoperatively (OR = 9.16). We found that the Frankel scale weakly correlated with the degree of spinal cord compression. In this study, other radiological parameters, such as the degree of cord compression and spinal canal occupation ratio, did not show a significant effect on the outcome. Conclusions: Surgery of intraspinal meningiomas can be considered safe. Neurological function improves in a large proportion of patients after surgery. However, a relevant preoperative deficit according to the Frankel scale (grade A–C) was a significant predictor of a postoperative neurological deterioration.
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spelling pubmed-106701722023-11-14 Predictors of Neurological Worsening after Resection of Spinal Meningiomas Jankovic, Dragan Kalasauskas, Darius Othman, Ahmed Brockmann, Marc A. Sommer, Clemens J. Ringel, Florian Keric, Naureen Cancers (Basel) Article SIMPLE SUMMARY: Despite the benign nature of these tumors, spinal meningiomas can cause significant neurological damage via compression of the spinal cord. In this study, we found that neurological function improves in a significant proportion of patients after surgery. Preoperative Frankel grade was a significant predictor of postoperative neurological worsening. Cross-section area measurements on MRI scans are not associated with early postoperative outcomes. ABSTRACT: Background: Due to the slow-growing nature of spinal meningiomas, they are mostly asymptomatic for a long time, and become symptomatic after the compression of the spinal cord or nerve roots. The aim of this study was to identify predictors for a poor clinical outcome after the surgical resection of spinal meningiomas and thereby to allow a preoperative identification of high-risk spinal meningiomas. Methods: Data acquisition was conducted as a single-center retrospective analysis. From 1 January 2004 to 31 December 2019, 121 patients who underwent surgical resection of a spinal meningioma were reviewed. Clinical and radiological data (such as tumor size, location, occupation ratio of the spinal canal, and the degree of spinal cord compression) were assessed. The functional clinical findings of the patients were recorded using the Karnofsky Performance Score, modified McCormick scale, and Frankel scale preoperatively, at discharge, and 3–6 months after surgery. Results: The mean patient age was 66 ± 13 years. A total of 104 (86%) patients were female and 17 (14%) were male. The thoracic spine (68%) was the most common location, followed by the cervical (29%) and lumbar (3%) spine. Preoperatively, 11.7% of patients were categorized as McCormick 1, 35.8% as 2, 39.2% as 3, 11.7% as 4, and 1.7% as 5. The neurological function of the patients with a functional deficit prior to surgery improved in 46% of the patients, remained unchanged in 52%, and worsened in 2% at discharge. At early follow-up, the proportions were 54%, 28%, and 5%, respectively. Preoperative Frankel scale was a significant predictor of a postoperative deterioration. Patients with Frankel score A to C preoperatively had a 9.2 times higher chance of clinical deterioration postoperatively (OR = 9.16). We found that the Frankel scale weakly correlated with the degree of spinal cord compression. In this study, other radiological parameters, such as the degree of cord compression and spinal canal occupation ratio, did not show a significant effect on the outcome. Conclusions: Surgery of intraspinal meningiomas can be considered safe. Neurological function improves in a large proportion of patients after surgery. However, a relevant preoperative deficit according to the Frankel scale (grade A–C) was a significant predictor of a postoperative neurological deterioration. MDPI 2023-11-14 /pmc/articles/PMC10670172/ /pubmed/38001667 http://dx.doi.org/10.3390/cancers15225408 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Jankovic, Dragan
Kalasauskas, Darius
Othman, Ahmed
Brockmann, Marc A.
Sommer, Clemens J.
Ringel, Florian
Keric, Naureen
Predictors of Neurological Worsening after Resection of Spinal Meningiomas
title Predictors of Neurological Worsening after Resection of Spinal Meningiomas
title_full Predictors of Neurological Worsening after Resection of Spinal Meningiomas
title_fullStr Predictors of Neurological Worsening after Resection of Spinal Meningiomas
title_full_unstemmed Predictors of Neurological Worsening after Resection of Spinal Meningiomas
title_short Predictors of Neurological Worsening after Resection of Spinal Meningiomas
title_sort predictors of neurological worsening after resection of spinal meningiomas
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10670172/
https://www.ncbi.nlm.nih.gov/pubmed/38001667
http://dx.doi.org/10.3390/cancers15225408
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