Spinal Meningiomas: 61 cases with predictors of early postoperative surgical outcomes.

BACKGROUND: Spinal meningiomas are benign, well-circumscribed and slowly growing intradural tumors that compress the spinal cord. Hereby, a retrospective review of 61 spinal meningioma cases evaluated in terms of demographic, clinical, pathological and radiological features to predict the early postoperative functional outcomes.

METHODS: Patients' records and MRI images of all the histologically confirmed spinal meningioma cases that underwent surgical resection at two university hospitals from January 2005 to June 2016 were retrospectively reviewed. Demographic data, clinical findings, radiological features and pathology reports were reviewed. Univariate and multivariate logistic regression analyses were used to evaluate the impact of each factor on the early 3-month post-surgical functional outcome. A receiver operating characteristic (ROC) curve was used to predict the power of the model.

RESULTS: 61 cases of spinal meningiomas were operated. 13 males (21%) and 48 females (79%). Mean age 60.5 years old ranging (24-92). Patients presented with back pain (57%), motor deficits (47.5%), sensory deficits (18%) and sphincteric dysfunction (11.5%). One case (1.6%) showed an additional extradural growth. 40 thoracic, 9 cervical, 5 cervicothoracic, 5 thoracolumbar and 2 lumbar cases. Only 4 cases (6.6%) showed atypical pathological features (WHO grade II). At 3-month follow up, 46 patients (75.4%) had either functionally improved or remained stable. 15 patients (24.6%) had "worse" functional outcome. Three variables showed statistically significant odds ratio for improved outcomes (OR): presurgical motor deficit (OR =5; p=0.005); pre - surgical sensory disturbance (OR=3.5; p=0.026); pre-surgical myelopathy (OR=3.5; P=0.026). Multivariate analysis showed increased OR for cross sectional ratio, pre-surgical myelopathy, pre-surgical radiculopathy and non - cervical location of tumor (1.59, 3.46, 3.2, 1.63/3.56 respectively). Although none has reached statistical significance (p>0.05), the receiver operating characteristic (ROC) curve showed an Area Under the Curve (AUC) of (0.74).

CONCLUSIONS: The independent predictors of the early postoperative functional outcomes of spinal meningioma resections may include pre-surgical motor deficit, sensory deficit and myelopathy.