Document Detail


Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management.
MedLine Citation:
PMID:  8874546     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Intraspinal meningiomas account for 25%-46% of primary spinal cord tumors. Technical advances in magnetic resonance imaging (MRI) and surgical procedures (ultrasonic cavitation aspirators [CUSA], lasers) have brought about better clinical results. In spite of these new techniques, a small percentage of patients still present with poor postoperative results and/or a recurrence. The authors tried to determine which data could influence clinical outcome and what therapeutic modalities could limit recurrence rate. MATERIALS AND METHODS: We reviewed 54 patients who from 1963 to 1994, each had surgery for an intraspinal meningioma. There were 43 females and 11 males, aged 8 to 85 years old. Thirty-six (66.6%) patients were ambulatory on admission; only 2 presented with a paraplegia. Tumor location was cervical in 10 cases, thoracic in 43 cases, lumbar in 1 case. Forty-seven tumors were intradural, 5 epidural, 2 epidural and intradural. Thirty patients underwent a myelography, 10 a computed tomography (CT) scan, and 14 an MRI. Twenty-three spinal angiographies were performed before surgery. Complete removal was achieved in 50 patients (92.6%). Ultrasonic cavitation was used 10 times for debulking the tumor, and laser was used in 12 surgical procedures to perform hemostasis of the meningioma and to coagulate the dural attachment. RESULTS: The majority of the neoplasms were meningothelial (N = 24) or psammomatous (N = 11). No mortality was noted. Morbidity concerned five patients: two pulmonary embolisms, one definitive paraplegia, one transient deficit, and one epidural suppuration, which necessitated a second operation. Mean follow-up was 28 months. Final functional results were very good in 85% and good in 13%; one patient (2%) worsened. Two recurrences were noted: one with clinical signs and the other with only CT-scan modifications. Both patients underwent complementary radiotherapy. DISCUSSION AND CONCLUSION: The authors discuss factors influencing functional results. Sex, pregnancy, pathologic diagnosis, and recurrence do not seem to have any influence. Calcification of the meningioma, as well as an anterior dural attachment, are pejorative factors. They insist on preoperative angiography and point out the advantage of using a CUSA and/or a laser to debulk and coagulate the tumor itself and its dural attachment. They propose radiation therapy as an adjuvant treatment or an alternative to reoperation, which could be hazardous for some patients when, for instance, a recurrence is located in a critical area or when the patient's general status is fragile.
Authors:
F X Roux; F Nataf; M Pinaudeau; G Borne; B Devaux; J F Meder
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Surgical neurology     Volume:  46     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  1996 Nov 
Date Detail:
Created Date:  1996-11-13     Completed Date:  1996-11-13     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  458-63; discussion 463-4     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, C.H. Sainte-Anne, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Child
Female
Follow-Up Studies
Humans
Male
Meningioma / diagnosis,  radiotherapy,  surgery*
Middle Aged
Neoplasm Recurrence, Local / diagnosis,  therapy
Pregnancy
Pregnancy Complications, Neoplastic / diagnosis,  surgery
Prognosis
Reoperation
Spinal Cord Neoplasms / diagnosis,  radiotherapy,  surgery*

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