Department of Neurosurgery and Neuro-oncology, First Medical Faculty, Central Military Hospital, Charles University in Prague, U Vojenské nemocnice 1200/1, 169 02, Prague 6, Czech Republic.
Acta Neurochir (Wien). 2020 Jun;162(6):1401-1408. doi: 10.1007/s00701-020-04280-2. Epub 2020 Mar 12.
The optimal treatment for spinal meningioma is complete resection. The radicality of resection is the most important predictive factor for future tumor recurrence. Although clinical series dedicated to spinal meningiomas are relatively frequent, only a minimum of these defines the length of the required follow-up and difference in tumor recurrence in the context of Simpson grade I and II resection. Therefore, we propose reconsideration of surgical treatment and long-term follow-up based on a retrospective analysis of 84 patients who underwent Simpson grade II resection.
The study included 84 patients operated between 1998 and 2018. Clinical symptomatology, age, sex, risk of comorbidities, spinal level, duration of symptoms, surgical resection radicality, tumor recurrence, and complications associated with treatment were recorded and evaluated.
We encountered the diagnosis of spinal meningioma considerably more often in women (81%) than in men (19%). The average age of all patients was 65 years. Most meningiomas were located in the thoracic spine (82%) while the rest (18%) were located in the cervical spine. The most common symptoms were motor deficit (80%) and sensation disorders (70%). Of the symptomatic patients, 71% clinically improved, 27% showed no change and 2% worsened postoperatively. The mean follow-up was 32 months (range 1-204). During this period, there was a 5% tumor recurrence rate. However, when we analyzed a subgroup of nine patients who were monitored for more than 6 years, tumor recurrence was diagnosed in 44%, all of whom were women (mean age 51 years).
Our results indicate that tumor recurrence after Simpson II resection could be significantly higher than previously thought if the follow-up is long enough, especially in younger patients. This finding suggests we consider using radical Simpson grade I resection more frequently. The study also demonstrates that after spinal meningioma surgery the patients should be followed and monitored on a long-term basis.
脊髓脊膜瘤的最佳治疗方法是完全切除。切除的彻底性是肿瘤复发的最重要预测因素。尽管专门针对脊髓脊膜瘤的临床系列相对常见，但只有极少数的临床系列定义了所需的随访时间以及 Simpson 分级 I 和 II 切除后肿瘤复发的差异。因此，我们基于对 84 例接受 Simpson 分级 II 切除的患者的回顾性分析，提出重新考虑手术治疗和长期随访。
该研究纳入了 1998 年至 2018 年间接受手术的 84 例患者。记录并评估了患者的临床症状、年龄、性别、合并症风险、脊柱节段、症状持续时间、手术切除的彻底性、肿瘤复发和与治疗相关的并发症。
我们发现，女性（81%）比男性（19%）更容易诊断为脊髓脊膜瘤。所有患者的平均年龄为 65 岁。大多数脊膜瘤位于胸椎（82%），其余（18%）位于颈椎。最常见的症状是运动障碍（80%）和感觉障碍（70%）。在有症状的患者中，71%的患者临床症状改善，27%的患者无变化，2%的患者术后恶化。平均随访时间为 32 个月（范围 1-204 个月）。在此期间，肿瘤复发率为 5%。然而，当我们分析了 9 名随访时间超过 6 年的患者亚组时，发现 44%的患者诊断为肿瘤复发，均为女性（平均年龄 51 岁）。
我们的结果表明，如果随访时间足够长，Simpson II 切除后肿瘤复发的可能性可能会显著高于先前的认识，尤其是在年轻患者中。这一发现表明我们应更频繁地考虑采用更彻底的 Simpson I 级切除。该研究还表明，脊髓脊膜瘤手术后，患者应进行长期随访和监测。
