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  • Updated 02.21.2024
  • Released 04.30.1996
  • Expires For CME 02.21.2027

Spinal meningioma



Spinal meningioma is a rare tumor usually presenting with chronic progressive radicular or myelopathic symptoms and back pain. The authors discuss the clinical manifestations, diagnosis, and management of this tumor. Surgical resection is the treatment of choice for patients with neurologic deficits. Some patients may benefit from the radiosurgery for recurrent or partially resected spine tumors.

Key points

• Spinal meningiomas are most frequently found in the thoracic area and are histologically grade 1 tumors over 90% of the time.

• Surgical intervention should be considered in most cases, particularly when patients present with neurologic deficits.

• The rates of overall complication, tumor recurrence, and poor functional outcome were 9.2%, 7.6%, and 5%, respectively, in one large case series. Age, revision surgery, and tumor recurrence were identified as independent predictors of poor functional outcome.

• Tumor calcification, which can reliably be detected with a CT scan, has been associated with longer operation times, more blood loss, and a significantly lower rate of neurologic improvement after surgery.

Historical note and terminology

In 1887 Horsley performed the first reported successful removal of an intradural, extramedullary tumor (32). With the support of Sir William Gowers, Horsley removed a "fibromyxoma" overlying the spinal cord at the T4 level. Postoperatively, the patient developed a debilitating pain syndrome, but later experienced a full neurologic recovery. In the following 50 years, pioneering neurosurgeons such as Elsberg, Frazier, and Cushing took particular interest in extramedullary tumors, recognizing their frequently benign nature and often dramatic recovery from profound neurologic deficit (30; 25; 17). The term "meningioma" was introduced by Cushing in his 1922 Cavendish lecture as a simple designation and is now universally employed. With the development of modern imaging, neuroanesthesia, and microsurgical techniques, Cushing's description of "one of the most gratifying of all operative procedures" is now the expected in most patients with intradural, extramedullary spinal tumors such as meningiomas (57; 47; 09; 48; 12; 73).

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