Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Surgery, Varberg Hospital, Varberg, Sweden.
Clin Neurol Neurosurg. 2021 Dec;211:107018. doi: 10.1016/j.clineuro.2021.107018. Epub 2021 Nov 16.
Spinal meningiomas are common primary tumors of the spinal canal and the resulting spinal cord compression (SCC) is intrinsically related to symptoms and outcome, but literature concerning this association is limited. We aimed to present data on both degree of SCC and tumor occupancy percentage in relation to neurological symptoms and outcome.
Patients ≥ 18 years with a histological diagnosis of spinal canal meningioma treated between 2000 and 2017 were retrospectively evaluated for symptoms and neurological outcome in relation to SCC (i.e. compression of spinal cord at maximal tumor compression compared to maximum area above/below compression) and tumor occupancy percentage (percentage of dural sac area occupied by tumor at maximal tumor compression). Area segmentation of spinal cord, tumor and dural sac (as marker of spinal canal) was performed manually on magnetic resonance imaging (MRI) scans. The neurological deficit was assessed pre- and postoperatively according to the McCormick score. A logistic regression was made with a training set to identify the cut-off level for motor deficit.
The cohort included 111 patients with a mean age of 62.5 years and 77.5% were female. The dominating symptoms preoperatively were sensory disturbance (91.0%), motor deficit (80.2%) and gait disturbance (67.6%). Postoperatively 53.2% of patients, also in some of those with severe deficit and high tumor occupancy, improved their neurological deficit and 43.2% were unchanged. Patients with intradural meningioma and assessable MRI scans were included to evaluate SCC (n = 83). The mean extent of SCC was 50.6%. Exploration of tumor occupancy percentage identified a cut-off at 65% tumor occupancy to best discriminate between patients with or without motor deficit.
Patients with an intradural tumor occupancy percentage of > 65% are more likely to have a preoperative symptom and deficit, validating previous findings. Therefore, we suggest that even in asymptomatic, otherwise fit, patients with tumor occupancy approaching 65% should be considered for surgery since there is a high risk of developing deficit with even minimal growth. Concerning recovery, patients with tumor both high tumor occupancy and significantly impaired function tended to improve their functional level postoperatively.
脊髓脊膜瘤是椎管内常见的原发性肿瘤，由此导致的脊髓压迫（SCC）与症状和预后密切相关，但相关文献有限。我们旨在提供与神经症状和预后相关的 SCC 严重程度和肿瘤占位百分比的数据。
回顾性分析 2000 年至 2017 年间接受治疗的、组织学诊断为椎管脊膜瘤的≥18 岁患者的症状和神经预后，分析 SCC（即最大肿瘤压迫时脊髓受压程度与最大受压上下脊髓面积之比）和肿瘤占位百分比（最大肿瘤压迫时肿瘤占硬脑膜囊面积的百分比）与神经症状和预后的关系。在磁共振成像（MRI）扫描上手动对脊髓、肿瘤和硬脑膜囊（作为椎管标志物）进行区域分割。术前和术后根据 McCormick 评分评估神经缺损情况。使用训练集进行逻辑回归，以确定运动缺损的截断水平。
该队列包括 111 名平均年龄为 62.5 岁的患者，其中 77.5%为女性。术前主要症状为感觉障碍（91.0%）、运动障碍（80.2%）和步态障碍（67.6%）。术后，53.2%的患者，包括一些有严重缺损和高肿瘤占位的患者，神经功能缺损得到改善，43.2%的患者无变化。纳入了可评估 MRI 扫描的硬脊膜内脊膜瘤患者以评估 SCC（n=83）。SCC 的平均程度为 50.6%。对肿瘤占位百分比的研究确定了 65%肿瘤占位的截断值，以最佳区分有无运动障碍的患者。
硬脊膜内肿瘤占位百分比>65%的患者更有可能出现术前症状和缺损，这验证了先前的发现。因此，我们建议，即使在无症状、身体状况良好的患者中，当肿瘤占位接近 65%时，也应考虑手术，因为即使肿瘤有极小的生长，也有发生缺损的高风险。关于恢复，肿瘤占位百分比高且功能严重受损的患者术后倾向于改善其功能水平。
