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Calcified spinal meningiomas: a systematic review of clinical characteristics, treatment strategies, and outcomes

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Abstract

Background

Calcified meningiomas involving the spine are rare but can pose significant surgical challenges. We systematically reviewed the literature on calcified spinal meningiomas.

Methods

PubMed, EMBASE, Web-of-Science, and Scopus databases were searched to include studies reporting clinical data of patients with calcified spinal meningioma. Included articles were analyzed for symptoms, imaging, spine level of the tumor, tumor location relative to the spinal cord, calcification status, treatment regimen, recurrence, progression-free survival, and outcomes.

Results

A total of 35 articles encompassing 94 patients were included. Most patients were female (90.4%), presenting with lower extremity weakness (44%) and/or lower extremity paresthesia (38.1%). Most calcified spinal meningiomas occurred in the thoracic spine (82%) and on the dorsal (33.3%) or ventral (27.2%) side relative to the spinal cord. Most tumors were intradural (87.2%). Histologically, most calcified spinal meningiomas were WHO grade I (97.4%) and psammomatous (50.7%). Most tumors demonstrated macroscopic calcification (48.9%). Most patients underwent gross total resection (91.5%) through a posterior approach (100%). Two patients (2.1%) received adjunctive radiotherapy. The most common treatment related complication was CSF leakage. Post-operatively, most patients demonstrated symptomatic improvement (75.5%) and 2 (2.1%) had local tumor recurrence.

Conclusions

Calcified spinal meningiomas are uncommon but benign entities. These neoplasms tend to adhere to surrounding tissues and nerves and, thus, can be surgically challenging to remove. In most patients, safe gross total resection remains the standard of care, but accurate surgical planning is necessary to reduce the risks of postoperative complications.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Levy WJ Jr, Bay J, Dohn D (1982) Spinal cord meningioma. J Neurosurg 57:804–812. https://doi.org/10.3171/jns.1982.57.6.0804

    Article  PubMed  Google Scholar 

  2. Parsa AT, Lee J, Parney IF, Weinstein P, McCormick PC, Ames C (2004) Spinal cord and intradural-extraparenchymal spinal tumors: current best care practices and strategies. J Neurooncol 69:291–318. https://doi.org/10.1023/b:neon.0000041889.71136.62

    Article  PubMed  Google Scholar 

  3. Schaller B (2005) Spinal meningioma: relationship between histological subtypes and surgical outcome? J Neurooncol 75:157–161. https://doi.org/10.1007/s11060-005-1469-4

    Article  PubMed  Google Scholar 

  4. Solero CL, Fornari M, Giombini S, Lasio G, Oliveri G, Cimino C, Pluchino F (1989) Spinal meningiomas: review of 174 operated cases. Neurosurgery 25:153–160

    Article  CAS  PubMed  Google Scholar 

  5. Doita M, Harada T, Nishida K, Marui T, Kurosaka M, Yoshiya S (2001) Recurrent calcified spinal meningioma detected by plain radiograph. Spine (Phila Pa 1976) 26:E249-252. https://doi.org/10.1097/00007632-200106010-00005

    Article  CAS  PubMed  Google Scholar 

  6. Klekamp J, Samii M (1999) Surgical results for spinal meningiomas. Surg Neurol 52:552–562. https://doi.org/10.1016/s0090-3019(99)00153-6

    Article  CAS  PubMed  Google Scholar 

  7. Naderi S, Yilmaz M, Canda T, Acar U (2001) Ossified thoracic spinal meningioma in childhood: a case report and review of the literature. Clin Neurol Neurosurg 103:247–249. https://doi.org/10.1016/s0303-8467(01)00157-3

    Article  CAS  PubMed  Google Scholar 

  8. Alafaci C, Grasso G, Granata F, Salpietro FM, Tomasello F (2016) Ossified spinal meningiomas: clinical and surgical features. Clin Neurol Neurosurg 142:93–97. https://doi.org/10.1016/j.clineuro.2016.01.026

    Article  PubMed  Google Scholar 

  9. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj 372:n71. https://doi.org/10.1136/bmj.n71

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ruggeri AG, Fazzolari B, Colistra D, Cappelletti M, Marotta N, Delfini R (2017) Calcified spinal meningiomas. World Neurosurg 102:406–412. https://doi.org/10.1016/j.wneu.2017.03.045

    Article  PubMed  Google Scholar 

  11. Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H OCEBM Levels of Evidence. Centre for Evidence-Based Medicine. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence. Accessed September 3, 2022

  12. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, Currie M, Lisy K, Qureshi R, Mattis P, Mu P (2020) Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E, Munn Z (eds) JBI Manual for Evidence Synthesis. JBI, 2020. Available from https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-08

  13. Freidberg SR (1972) Removal of an ossified ventral thoracic meningioma: case report. J Neurosurg 37:728–730. https://doi.org/10.3171/jns.1972.37.6.0728

    Article  CAS  PubMed  Google Scholar 

  14. Messori A, Rychlicki F, Salvolini U (2002) Spinal epidural en-plaque meningioma with an unusual pattern of calcification in a 14-year-old girl: case report and review of the literature. Neuroradiology 44:256–260. https://doi.org/10.1007/s00234-001-0709-3

    Article  CAS  PubMed  Google Scholar 

  15. Deen HG, Fenton DS (2004) Discovery of thoracic meningioma with cord compression on a screening “total body” computed topography scan. Spine J 4:706–708. https://doi.org/10.1016/j.spinee.2004.04.007

    Article  PubMed  Google Scholar 

  16. Liu CL, Lai PL, Jung SM, Liao CC (2006) Thoracic ossified meningioma and osteoporotic burst fracture: treatment with combined vertebroplasty and laminectomy without instrumentation: case report. J Neurosurg Spine 4:256–259. https://doi.org/10.3171/spi.2006.4.3.256

    Article  PubMed  Google Scholar 

  17. Tahir M, Usmani N, Ahmad FU, Salmani S, Sharma MS (2009) Spinal meningioma containing bone: a case report and review of literature. BMJ Case Rep. https://doi.org/10.1136/bcr.11.2008.1186

    Article  PubMed  PubMed Central  Google Scholar 

  18. Uchida K, Nakajima H, Yayama T, Sato R, Kobayashi S, Mwaka ES, Imamura Y, Baba H (2009) Immunohistochemical findings of multiple ossified en plaque meningiomas in the thoracic spine. J Clin Neurosci 16:1660–1662. https://doi.org/10.1016/j.jocn.2009.03.013

    Article  PubMed  Google Scholar 

  19. Licci S, Limiti MR, Callovini GM, Bolognini A, Gammone V, Di Stefano D (2010) Ossified spinal tumour in a 58-year-old woman with increasing paraparesis. Neuropathology 30:194–196. https://doi.org/10.1111/j.1440-1789.2009.01076.x

    Article  PubMed  Google Scholar 

  20. Lunardi P, Hammam M, Corinaldesi R, Novegno F, Lunardi T, Floris R (2012) The diagnostic pitfalls of C1–C2 extradural calcified meningiomas: a case report. Clin Neuroradiol 22:263–268. https://doi.org/10.1007/s00062-011-0103-4

    Article  CAS  PubMed  Google Scholar 

  21. Abolfotoh M, Tavanaiepour D, Hong C, Dunn IF, Lidov H, Al-Mefty O (2012) Primary calcified rhabdoid meningioma of the cranio-cervical junction: a case report and review of literature. J Craniovertebr Junction Spine 3:32–37. https://doi.org/10.4103/0974-8237.110127

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chotai SP, Mrak RE, Mutgi SA, Medhkour A (2013) Ossification in an extra-intradural spinal meningioma-pathologic and surgical vistas. Spine J 13:e21-26. https://doi.org/10.1016/j.spinee.2013.06.102

    Article  PubMed  Google Scholar 

  23. Ju CI, Hida K, Yamauchi T, Houkin K (2013) Totally ossified metaplastic spinal meningioma. J Korean Neurosurg Soc 54:257–260. https://doi.org/10.3340/jkns.2013.54.3.257

    Article  PubMed  PubMed Central  Google Scholar 

  24. Chan T-T, Lau VW-H, Chau TK-F, Lee Y-L (2014) Ossified thoracic spinal meningioma with lamellar bone formation presented with paraparesis. J Orthop Trauma Rehabi 18:106–109. https://doi.org/10.1016/j.jotr.2013.06.001

    Article  Google Scholar 

  25. Zhu Q, Qian M, Xiao J, Wu Z, Wang Y, Zhang J (2013) Myelopathy due to calcified meningiomas of the thoracic spine: minimum 3-year follow-up after surgical treatment. J Neurosurg Spine 18:436–442. https://doi.org/10.3171/2013.2.Spine12609

    Article  PubMed  Google Scholar 

  26. Yamane K, Tanaka M, Sugimoto Y, Ichimura K, Ozaki T (2014) Spinal metaplastic meningioma with osseous differentiation in the ventral thoracic spinal canal. Acta Med Okayama 68:313–316. https://doi.org/10.18926/amo/52901

    Article  PubMed  Google Scholar 

  27. Erdi F, Kaya B, Karatas Y, Esen H, Ustun ME (2014) Diffuse ossified meningioma of the upper thoracic spine: a case report. Neurosurg Q 24:240–242. https://doi.org/10.1097/WNQ.0b013e3182a2fb9e

    Article  Google Scholar 

  28. Miyakoshi N, Hongo M, Kasukawa Y, Shimada Y (2015) En-bloc resection of thoracic calcified meningioma with inner dural layer in recapping T-saw laminoplasty: a case report. BMC Surg 15:82. https://doi.org/10.1186/s12893-015-0066-5

    Article  PubMed  PubMed Central  Google Scholar 

  29. Reddy S, Pulligopu AK, Kumar A, Sahu BP (2015) Metaplastic conus meningioma and its applied aspects. Asian J Neurosurg 10:166–168. https://doi.org/10.4103/1793-5482.153498

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cochran EJ, Schlauderaff A, Rand SD, Eckardt GW, Kurpad S (2016) Spinal osteoblastic meningioma with hematopoiesis: radiologic-pathologic correlation and review of the literature. Ann Diagn Pathol 24:30–34. https://doi.org/10.1016/j.anndiagpath.2016.07.002

    Article  PubMed  Google Scholar 

  31. Dickerman RD, Reynolds AS, McDonald C (2017) Trap-door durotomy for ventral calcified thoracic meningioma. Interdisciplinary Neurosurgery 8:33–34. https://doi.org/10.1016/j.inat.2017.01.006

    Article  Google Scholar 

  32. Foster M, Soh C, DuPlessis D, Karabatsou K (2016) Circumferential intradural meningioma of the thoracic spinal cord. Spine J 16:e479-483. https://doi.org/10.1016/j.spinee.2016.02.053

    Article  PubMed  Google Scholar 

  33. Prakash A, Mishra S, Tyagi R, Attri PC, Bhatnagar A, Kansal S (2017) Thoracic psammomatous spinal meningioma with osseous metaplasia: a very rare case report. Asian J Neurosurg 12:270–272. https://doi.org/10.4103/1793-5482.150222

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sakamoto K, Tsutsumi S, Nonaka S, Suzuki T, Ishii H, Ito M, Yasumoto Y (2018) Ossified extradural en-plaque meningioma of the cervical spine. J Clin Neurosci 50:124–126. https://doi.org/10.1016/j.jocn.2018.01.058

    Article  PubMed  Google Scholar 

  35. Murakami T, Tanishima S, Takeda C, Kato S, Nagashima H (2019) Ossified metaplastic spinal meningioma without psammomatous calcification: a case report. Yonago Acta Med 62:232–235. https://doi.org/10.33160/yam.2019.06.008

    Article  PubMed  PubMed Central  Google Scholar 

  36. Taha MM, Alawamry A, Abdel-Aziz HR (2019) Ossified spinal meningioma: a case report and a review of the literature. Surg J (NY) 5:e137–e141. https://doi.org/10.1055/s-0039-1697634

    Article  Google Scholar 

  37. Wang C, Chen Y, Zhang L, Ma X, Chen B, Li S (2019) Thoracic psammomatous meningioma with osseous metaplasia: a controversial diagnosis of a case report and literature review. World J Surg Oncol 17:150. https://doi.org/10.1186/s12957-019-1694-5

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sadrameli SS, Chan TM, Lee JJ, Desai VR, Holman PJ (2020) Resection of spinal meningioma using ultrasonic bonescalpel microshaver: cases, technique, and review of the literature. Oper Neurosurg (Hagerstown) 19:715–720. https://doi.org/10.1093/ons/opaa223

    Article  PubMed  Google Scholar 

  39. Xu F, Tian Z, Qu Z, Yao L, Zou C, Han W, Zhang C, Fu C, Wang Y (2020) Completely ossified thoracic intradural meningioma in an elderly patient: a case report and literature review. Medicine (Baltimore) 99:e20814. https://doi.org/10.1097/md.0000000000020814

    Article  PubMed  Google Scholar 

  40. Buchanan D, Martirosyan NL, Yang W, Buchanan RI (2021) Thoracic meningioma with ossification: case report. Surg Neurol Int 12:505. https://doi.org/10.25259/sni_643_2021

    Article  PubMed  PubMed Central  Google Scholar 

  41. Nguyen BQ, Tran DDT, Dang TC, Mai TD, Pham HD, Truong VT (2021) Cervical intra-extradural meningioma with en-plaque, dumbbell-shaped, and an unusual calcified pattern in a young patient. Surg Neurol Int 12:454. https://doi.org/10.25259/sni_615_2021

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wong YP, Tan GC, Mukari SAM, Palaniandy K (2021) Heterotopic ossification in psammomatous spinal meningioma: a diagnostic controversy. Int J Clin Exp Pathol 14:627–632

    PubMed  PubMed Central  Google Scholar 

  43. Thakur J, Ulrich CT, Schär RT, Seidel K, Raabe A, Jesse CM (2021) The surgical challenge of ossified ventrolateral spinal meningiomas: tricks and pearls for managing large ossified meningiomas of the thoracic spine. J Neurosurg Spine 35:516–526. https://doi.org/10.3171/2020.12.Spine201526

    Article  PubMed  Google Scholar 

  44. Visco ZR, Liu DD, Leary OP, Oyelese AA, Gokaslan ZL, Camara-Quintana JQ, Galgano MA (2021) A transpedicular approach to complex ventrally situated thoracic intradural extramedullary tumors: technique, indications, and multiinstitutional case series. Neurosurg Focus 50:E19. https://doi.org/10.3171/2021.2.Focus20968

    Article  PubMed  Google Scholar 

  45. Kubota T, Yamashima T, Hasegawa M, Kida S, Hayashi M, Yamamoto S (1986) Formation of psammoma bodies in meningocytic whorls. Ultrastructural study and analysis of calcified material. Acta Neuropathol 70:262–268. https://doi.org/10.1007/bf00686081

    Article  CAS  PubMed  Google Scholar 

  46. Phimphilai M, Zhao Z, Boules H, Roca H, Franceschi RT (2006) BMP signaling is required for RUNX2-dependent induction of the osteoblast phenotype. J Bone Miner Res 21:637–646. https://doi.org/10.1359/jbmr.060109

    Article  CAS  PubMed  Google Scholar 

  47. Yayama T, Furusawa N, Baba H, Kokubo Y, Yoshizawa K, Fukuda M (2003) Calcium crystal deposition in the ligamentum flavum of the lumbar spine: role of sex hormones and transforming growth factor-&beta. Acta Histochem Cytochem 36:83–91. https://doi.org/10.1267/ahc.36.83

    Article  CAS  Google Scholar 

  48. Yayama T, Kobayashi S, Sato R, Uchida K, Kokubo Y, Nakajima H, Takamura T, Mwaka E, Orwotho N, Baba H (2008) Calcium pyrophosphate crystal deposition in the ligamentum flavum of degenerated lumbar spine: histopathological and immunohistological findings. Clin Rheumatol 27:597–604. https://doi.org/10.1007/s10067-007-0754-3

    Article  PubMed  Google Scholar 

  49. Yaşargil MG, Tranmer BI, Adamson TE, Roth P (1991) Unilateral partial hemi-laminectomy for the removal of extra- and intramedullary tumours and AVMs. Adv Tech Stand Neurosurg 18:113–132. https://doi.org/10.1007/978-3-7091-6697-0_3

    Article  PubMed  Google Scholar 

  50. Lee SE, Jahng TA, Kim HJ (2015) Different surgical approaches for spinal schwannoma: a single surgeon’s experience with 49 consecutive cases. World Neurosurg 84:1894–1902. https://doi.org/10.1016/j.wneu.2015.08.027

    Article  PubMed  Google Scholar 

  51. Kim CH, Chung CK (2011) Surgical outcome of a posterior approach for large ventral intradural extramedullary spinal cord tumors. Spine (Phila Pa 1976) 36:E531-537. https://doi.org/10.1097/BRS.0b013e3181dc8426

    Article  PubMed  Google Scholar 

  52. Yolcu YU, Goyal A, Alvi MA, Moinuddin FM, Bydon M (2019) Trends in the utilization of radiotherapy for spinal meningiomas: insights from the 2004–2015 national cancer database. Neurosurg Focus 46:E6. https://doi.org/10.3171/2019.3.Focus1969

    Article  PubMed  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Dell Medical School, Austin, TX, USA

    Darsh S. Shah

  2. Deparment of Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

    Raghuram V. Reddy

  3. Department of Neurosurgery, Yeditepe University School of Medicine, Istanbul, Turkey

    Yücel Doğruel

  4. Department of Neurosurgery, Nasser Institute for Research and Treatment Hospital, Cairo, Egypt

    Mohamed Z. Asfour

  5. Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Ahmad Pour-Rashidi

  6. Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Ali S. Haider

  7. Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA

    Mayur Sharma

  8. Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Salah G. Aoun

  9. Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy

    Giuseppe E. Umana

  10. Department of Neurosurgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA

    Paolo Palmisciano

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Contributions

All authors contributed to the study conception and design. The study was conceptualized and supervised by PP. Material preparation, data collection and analysis were performed by DSS and RVR. The first draft of the manuscript was written by DSS and RVR, YD, MZA, AP, ASH, MS, SA, GEU, and PP reviewed and commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Paolo Palmisciano.

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Shah, D.S., Reddy, R.V., Doğruel, Y. et al. Calcified spinal meningiomas: a systematic review of clinical characteristics, treatment strategies, and outcomes. J Neurooncol 162, 295–305 (2023). https://doi.org/10.1007/s11060-023-04291-w

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