|Perneczky G et al.|
Spinal Meningiomas: A Comprehensive Overview and Own Experience
European Association of NeuroOncology Magazine 2013; 3 (3): 118-121
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Keywords: neurosurgery, spinal meningioma, spinal tumour
Among intradural extramedullary tumours, neurinomas followed by meningiomas are the most common histological entities. Spinal menigiomas constitute only for 7.5–12.7 % of all meningiomas. More than 2/3 of all spinal meningiomas are located in the thoracic spine. 86–95 % of the tumours are found purely intradurally.
Risk factors are ionizing radiation, genetic predisposition, and female gender.
For diagnosis, the methods of choice are magnetic resonance imaging scans, including T1- and T2-weighted images, with and without contrast agent. They show spheric contrast-enhancing tumours with their intradural and extra-medullar localizations. The tumour matrix is typically in a lateral position. Sometimes it is difficult to differentiate meningiomas from neurinomas in the rare cases when meningiomas grow intra- and extradurally (dumbbell tumours). Distinct calcifications, which can be recognized in computed tomography, suggest a meningioma. Larger cystic areas rather indicate a neurinoma.
The treatment of choice is surgical removal using intraoperative ultrasound (for ideal tumour localization) and intraoperative neuromonitoring (for functional preservation). For surgery, we prefer the dorsal approach except for a few cases, sometimes laterally extended by partial resection of the vertebral joint or the head of rib in the area of the thoracic spine.
Postoperatively, the great majority of patients have excellent postoperative outcomes. In our own recent series between 1/2010 and 12/2012, 80 patients were operated on spinal tumours with 27 patients harbouring meningiomas (34 %). More than 90 % (26/27) showed clinical improvement with ameliorated gait pattern or even restarted walking without assistance.