Surgical results for spinal meningiomas

Among a series of 782 spinal tumors, 130 spinal meningiomas in 117 patients were operated in the Department of Neurosurgery at the Nordstadt Hospital in Hannover, Germany, between 1977 and 1998. Patients were followed postope ratively for up to 13 years (mean 20 +/- 33 months). Comparing the period o f 1977 through 1987, before magnetic resonance imaging (MRI) was available, to the period of 1988 to 1998 revealed that the average history until diag nosis shortened by about 6 months during the second decade of this study (2 4 +/- 33 to 18 +/- 29 months; not significant). Consequently, the preoperative Karnofsky Score increased significantly (59 +/- 15 and 66 +/- 16; p < 0.05). The rates of complete resection and the po stoperative neurological outcome, however, remained unchanged. Even though the overall prognosis of neurological deficits is favorable aft er complete resection of a meningioma, a subset of 18 patients had either e n plaque growing or recurrent tumors that were more likely to be removed in completely and to cause postoperative neurological problems, with a signifi cantly worse Karnofsky Score after 1 year (57 +/- 12 and 77 +/- 12, respect ively; p < 0.01) and a significantly higher recurrence rate after 5 years ( 86.7% and 20.4%, respectively; log rank test p = 0.0014). In conclusion, a favorable postoperative neurological outcome requires comp lete resection of the spinal meningioma. The advent of MRI has shortened th e time until diagnosis and made it possible to perform surgery before sever e deficits have occurred, but did not have a major impact on postoperative results. En plaque and recurrent meningiomas remain surgical challenges, as infiltration of surrounding structures and associated arachnoid scarring m ay render complete resection difficult to achieve. (C) 1999 by Elsevier Sci ence Inc.