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Spinal Meningiomas Prognostic Evaluation Score (SPES): predicting the neurological outcomes in spinal meningioma surgery

  • Alessandro Frati
  • Alessandro PesceEmail author
  • Giada Toccaceli
  • Flavia Fraschetti
  • Riccardo Caruso
  • Antonino Raco
Original Article
  • 93 Downloads

Abstract

Among many factors leading to a worse functional prognosis in spinal meningioma (SM) surgery, in a previous study, we recognized anterior/anterolateral axial topography, sphincter involvement at first evaluation, surgery performed on a recurrence, and worse preoperative functional status. The purpose of this paper is to evaluate the cumulative weight of these factors on prognosis through a multinomial logistic regression model performed on an original evaluation scale designed by the authors on the ground of the experience of the neurosurgical departments of our University. The original SM database composed of 173 cases was classified in regard to sex, age, symptoms, axial and sagittal location, Simpson grade resection, and functional pre/postoperative status. Fine presurgical and follow-up reevaluations were available. The authors propose a scale (Spinal Meningiomas Prognostic Evaluation Score (SPES)) of preoperative evaluation to assess the surgery-related risk of neurological worsening experienced by the patients included in the present cohort. The authors describe a strong statistical association between the SPES and the follow-up Frankel and McCormick scores (r = − 460 and .441, p .001, both). Through a univariate ANOVA analysis, we disclosed that patients presenting scores 2 and 3 had a significantly higher association to lesser Frankel and McCormick postoperative scores, in respect to patients presenting SPES scores 0–1 (univariate ANOVA, p .008 and .011). Anterior or anterolateral axial location, operating on a recurrence of SM, sphincter involvement, and worse functional grade at onset present, along with the SPES scores are fairly predictive and reliable in respect to the long-term results of patients suffering from SM.

Keywords

Intradural Extramedullary Meningioma Multinomial logistic regression Spinal cord 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The present paper contains results obtained from a retrospective study. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study. No identifying information about participants is available in the article.

Supplementary material

10143_2018_961_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 19 kb)

References

  1. 1.
    Aboul-Enein HA, Khidr WM, Abdeen KM, Madawi AA (2015) Surgical management of ventrally based lower cervical (subaxial) meningiomas through the lateral approach: report on 16 cases. Clin Neurol Neurosurg 139:152–158CrossRefPubMedGoogle Scholar
  2. 2.
    Alafaci C, Grasso G, Granata F, Salpietro FM, Tomasello F (2016) Ossified spinal meningiomas: clinical and surgical features. Clin Neurol Neurosurg 142:93–97CrossRefPubMedGoogle Scholar
  3. 3.
    Arima H, Takami T, Yamagata T, Naito K, Abe J, Shimokawa N, Ohata K (2014) Surgical management of spinal meningiomas: a retrospective case analysis based on preoperative surgical grade. Surg Neurol Int 5(Suppl 7):S333–S338PubMedPubMedCentralGoogle Scholar
  4. 4.
    Bayoumi AB, Laviv Y, Karaali CN, Ertilav K, Kepoglu U, Toktas ZO, Konya D, Kasper EM (2017) Spinal Meningiomas: 61 cases with predictors of early postoperative surgical outcomes. J Neurosurg Sci.  https://doi.org/10.23736/S0390-5616.17.04102-9
  5. 5.
    Bayoumi AB, Laviv Y, Yokus B, Efe IE, Toktas ZO, Kilic T, Demir MK, Konya D, Kasper EM (2017) Proposal of a new radiological classification system for spinal meningiomas as a descriptive tool and surgical guide. Clin Neurol Neurosurg 162:118–126CrossRefPubMedGoogle Scholar
  6. 6.
    Bettaswamy G, Ambesh P, Das KK, Sahu R, Srivastava A, Mehrotra A, Jaiswal A, Jaiswal S, Behari S (2016) Extradural spinal meningioma: revisiting a rare entity. J Craniovertebr Junction Spine 7(1):65–68CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Caroli E, Acqui M, Roperto R, Ferrante L, D’Andrea G (2004) Spinal en plaque meningiomas: a contemporary experience. Neurosurgery 55(6):1275–1279CrossRefPubMedGoogle Scholar
  8. 8.
    Cohen-Gadol AA, Zikel OM, Koch CA, Scheithauer BW, Krauss WE (2003) Spinal meningiomas in patients younger than 50 years of age: a 21-year experience. J Neurosurg 98(3):258–263PubMedGoogle Scholar
  9. 9.
    Cushing H, Eisenhardt L (1938) Meningiomas. Their classification, regional behaviour, life history, and surgical end results. Bull Med Libr Assoc 27(2):185Google Scholar
  10. 10.
    Davies S, Gregson B, Mitchell P (2017) Spinal meningioma: relationship between degree of cord compression and outcome. Br J Neurosurg 31(2):209–211CrossRefPubMedGoogle Scholar
  11. 11.
    Freidberg SR (1972) Removal of an ossified ventral thoracic meningioma: case report. J Neurosurg 37(6):728–730CrossRefPubMedGoogle Scholar
  12. 12.
    Gezen F, Kahraman S, Çanakci Z, Bedük A. (2000) Review of 36 cases of spinal cord meningioma. Spine 25(6):727–731Google Scholar
  13. 13.
    Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E, von Deimling A, Stavrinou P, Lefranc F, Lund-Johansen M, Moyal EC (2016) EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol 17(9):e383–e391CrossRefPubMedGoogle Scholar
  14. 14.
    Grimm S, Chamberlain MC (2009) Adult primary spinal cord tumors. Expert Rev Neurother 9(10):1487–1495.  https://doi.org/10.1586/ern.09.101 CrossRefPubMedGoogle Scholar
  15. 15.
    King AT, Sharr MM, Gullan RW, Bartlett JR (1998) Spinal meningiomas: a 20-year review. Br J Neurosurg 12(6):521–526CrossRefPubMedGoogle Scholar
  16. 16.
    Klekamp J, Samii M (1999) Surgical results for spinal meningiomas. Surg Neurol 52(6):552–562CrossRefPubMedGoogle Scholar
  17. 17.
    Levy WJ Jr, Bay J, Dohn D (1982) Spinal cord meningioma. J Neurosurg 57:804–812CrossRefPubMedGoogle Scholar
  18. 18.
    Maiti TK, Bir SC, Patra DP, Kalakoti P, Guthikonda B, Nanda A (2016) Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome. Neurosurg Focus 41(2):E6CrossRefPubMedGoogle Scholar
  19. 19.
    Maiuri F, De Caro MDB, de Divitiis O, Vergara P, Mariniello G (2011) Spinal meningiomas: age-related features. Clin Neurol Neurosurg 113(1):34–38CrossRefPubMedGoogle Scholar
  20. 20.
    Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL (1985) Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62(1):18–24CrossRefPubMedGoogle Scholar
  21. 21.
    Nakamura M, Tsuji O, Fujiyoshi K, Hosogane N, Watanabe K, Tsuji T, Ishii K, Toyama Y, Chiba K, Matsumoto M (2012) Long-term surgical outcomes of spinal meningiomas. Spine 37(10):E617–E623CrossRefPubMedGoogle Scholar
  22. 22.
    Oshima Lee E, Emanuel EJ (2013) Shared decision making to improve care and reduce costs. New Engl J Med 368(1):6–8CrossRefPubMedGoogle Scholar
  23. 23.
    Pena M, Galasko CS, Barrie JL (1992) Delay in diagnosis of intradural spinal tumors. Spine 17:1110–1116CrossRefPubMedGoogle Scholar
  24. 24.
    Raco A, Pesce A, Toccaceli G, Domenicucci M, Miscusi M, Delfini R (2017) Factors leading to a poor functional outcome in spinal meningioma surgery: remarks on 173 cases. Neurosurgery 80(4):602–609CrossRefPubMedGoogle Scholar
  25. 25.
    Roux FX, Nataf F, Pinaudeau M, Borne G, Devaux B, Meder JF (1996) Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol 46(5):458–464CrossRefPubMedGoogle Scholar
  26. 26.
    Sandalcioglu IE, Hunold A, Müller O, Bassiouni H, Stolke D, Asgari S (2008) Spinal meningiomas: critical review of 131 surgically treated patients. Eur Spine J 17(8):1035–1041CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Saraceni C, Harrop JS (2009) Spinal meningioma: chronicles of contemporary neurosurgical diagnosis and management. Clin Neurol Neurosurg 111(3):221–226CrossRefPubMedGoogle Scholar
  28. 28.
    Schaller B (2005) Spinal meningioma: relationship between histological subtypes and surgical outcome? J Neuro-oncol 75(2):157–161CrossRefGoogle Scholar
  29. 29.
    Setzer M, Vatter H, Marquardt G, Seifert V, Vrionis FD (2007) Management of spinal meningiomas: surgical results and a review of the literature. Neurosurg Focus 23(4):E14, 1–12CrossRefGoogle Scholar
  30. 30.
    Shay LA, Lafata JE (2015) Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Mak 35(1):114–131CrossRefGoogle Scholar
  31. 31.
    Solero CL, Fornari M, Giombini S, Lasio G, Oliveri G, Cimino C, Pluchino F (1989) Spinal meningiomas: review of 174 operated cases. Neurosurgery 25(2):153–160CrossRefPubMedGoogle Scholar
  32. 32.
    Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Légaré F, Thomson R (2011) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 10:CD001431–CD001431Google Scholar
  33. 33.
    Sun SQ, Cai C, Ravindra VM, Gamble P, Yarbrough CK, Dacey RG, Dowling JL, Zipfel GJ, Wright NM, Santiago P, Robinson CG (2015) Simpson Grade I-III resection of spinal atypical (World Health Organization Grade II) meningiomas is associated with symptom resolution and low recurrence. Neurosurgery 76(6):739–746CrossRefPubMedGoogle Scholar
  34. 34.
    Westwick HJ, Shamji MF (2015) Effects of sex on the incidence and prognosis of spinal meningiomas: a surveillance, epidemiology, and end results study. J Neurosurg Spine 23(3):368–373CrossRefPubMedGoogle Scholar
  35. 35.
    Westwick HJ, Yuh SJ, Shamji MF (2015) Complication avoidance in the resection of spinal meningiomas. World Neurosurg 83(4):627–634CrossRefPubMedGoogle Scholar
  36. 36.
    Yoon SH, Chung CK, Jahng TA (2007) Surgical outcome of spinal canal meningiomas. J Korean Neurosurg Soc 42(4):300–304CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Zham H, Moradi A, Rakhshan A, Zali A, Rahbari A, Raee M, Ashrafi F, Ahadi M, Larijani L, Baikpour M, Khayamzadeh M. (2016). Does histologic subtype influence the post-operative outcome in spinal meningioma? Iran J Cancer Prev 9(2)Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.IRCCS “Neuromed” Neurosurgery DepartmentSapienza UniversityRomeItaly
  2. 2.NESMOS Department Neurosurgery DepartmentSapienza UniversityRomeItaly
  3. 3.Azienda Universitario-Ospedaliera Sant’AndreaRomeItaly
  4. 4.Neurosurgery Division of “Neurology and Psychiatry” DepartmentSapienza UniversityRomeItaly

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