Current Knowledge on Spinal Meningiomas—Surgical Treatment, Complications, and Outcomes: A Systematic Review and Meta-Analysis (Part 2)

SIMPLE SUMMARY: Spinal meningiomas are the most common adult primary intradural spinal tumors. There are no recent comprehensive reviews summarizing the current state of the evidence for spinal meningiomas. This review aims to cover all relevant studies on spinal meningiomas published over the past 20 years. Three electronic databases were systematically searched, and 104 studies were identified. Briefly, spinal meningioma surgery is a safe procedure. The most relevant predictors of unfavorable outcome were poor preoperative status, longer time to surgery, and surgery for recurrent tumors. Our analysis revealed that higher WHO grade, higher Simpson grade, ventral tumor location, and male sex were all associated with higher odds of recurrence. Finally, surgery was associated with significant improvements in health-related quality-of-life. ABSTRACT: Background: Most of the knowledge on spinal meningiomas is extrapolated from their intracranial counterparts, even though they are considered separate entities. This review aimed to systematically summarize studies covering different aspects of spinal meningiomas and their management. Methods: Databases were searched for all studies concerning spinal meningiomas dating from 2000 and onwards. When possible, a meta-analysis was performed. Results: Neurological outcomes of surgery were consistently favorable across studies, with a complication rate of 7.9% and 78.9% of the patients demonstrating good postoperative neurological function (McCormick score 1–2). The most relevant predictors of unfavorable outcomes were poor preoperative status, longer time from diagnosis to surgery, and surgery of recurrent tumors. The recurrence rate after surgery was estimated at 6%. Meta-analysis and/or survival analysis revealed that higher WHO grade (p < 0.001), higher Simpson grade (p < 0.001), ventral tumor location (p = 0.02), and male sex (p = 0.014) were all associated with higher odds of recurrence. However, the meta-analysis did not show any difference between Simpson grade 1 and grade 2 with respect to the odds of recurrence (p = 0.94). Surgery provided immediate and durable health-related quality-of-life improvement, as well as a high frequency of return to work. Conclusion: Spinal meningioma surgery is a relatively safe procedure with a low risk of tumor recurrence and high likelihood of favorable postoperative outcomes.