Advertisement

Spinal Meningioma

  • Nima Alan
  • John C. Flickinger
  • Peter Carlos Gerszten
Chapter

Abstract

Spinal meningiomas are benign extramedullary tumors arising from the arachnoid cap cells that predominantly affect females in the fifth to seventh decade of life. They most frequently occur in the thoracic spine. Magnetic resonance imaging is the imaging modality of choice for diagnosis, demonstrating avid homogenous enhancement of an extramedullary mass with or without both intra- and extradural components. Open surgical resection remains the mainstay of treatment for spinal meningiomas. Conventional fractionated radiotherapy and more recently hypofractionated radiosurgery have been employed in certain cases. Radiotherapy may be considered for the management of patients with residual or recurrent tumors after resection, in those patient whose tumors are not amenable to open surgical resection due to anatomical location or for patients who are not surgical candidates. Doses of 45–54 Gy using fractions of 1.8 Gy are recommended. More recently, conformal radiosurgery may be preferred over conventional radiotherapy for the treatment of these benign tumors. MRI is the imaging modality of choice for radiosurgical planning. Doses of 12–16 Gy have been described for hypofractionated radiosurgery in a single session, 18 Gy for three fractions, and 25–30 Gy for five fractions regimens. The complication of radiation-induced spinal cord injury has a rather low incidence. This complication can be avoided by optimizing total prescribed dose, fraction size, and careful delineation of both the target and neural structures. Similar to well-documented experience for intracranial meningiomas, the radiosurgical management for spinal meningiomas is a highly safe and effective treatment modality associated with long-term radiographic control.

Keywords

Spinal meningioma Radiosurgery Spinal radiation Spinal tumors Benign tumors of the spine WHO grade I meningioma 

References

  1. 1.
    Helseth A, Mork SJ. Primary intraspinal neoplasms in Norway, 1955 to 1986. A population-based survey of 467 patients. J Neurosurg. 1989;71:842–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Solero CL, Fornari M, Giombini S, et al. Spinal meningiomas: review of 174 operated cases. Neurosurgery. 1989;25:153–60.CrossRefPubMedGoogle Scholar
  3. 3.
    Gottfried ON, Gluf W, Quinones-Hinojosa A, et al. Spinal meningiomas: surgical management and outcome. Neurosurg Focus. 2003;14(6):e2.CrossRefPubMedGoogle Scholar
  4. 4.
    Parisi JE, Mena H. Nonglial tumors. In: Nelson JS, Parisi JE, Schochet Jr SS, editors. Principles and practice of neuropathology. St. Louis: Mosby; 1993. p. 203–66.Google Scholar
  5. 5.
    Levy WJ, Latchaw J, Hahn JF, et al. Spinal neurofibromas: a report of 66 cases and a comparison with meningiomas. Neurosurgery. 1986;18(3):331–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Dickman CA, Fehlings MG, Gokaslan ZL. Spinal column and spinal column tumors: principles and practice. New York: Thieme Medical Publishers; 2006. p. 335–48.Google Scholar
  7. 7.
    King AT, Sharr MM, Gullan RW, et al. Spinal meningiomas: a 20-year review. Br J Neurosurg. 1998;12:521–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Gezen F, Kahraman S, Canakci Z, et al. Review of 36 cases of spinal cord meningioma. Spine. 2000;25:727–31.CrossRefPubMedGoogle Scholar
  9. 9.
    Matsumoto S, Hasuo K, Uchino A, et al. MRI of intradural extramedullary spinal neurinomas and meningiomas. Clin Imaging. 1993;17:46–52.CrossRefPubMedGoogle Scholar
  10. 10.
    Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization Classification of tumors of the central nervous system: a summary. Acta Neruopathol. 2016;131:803–20.CrossRefGoogle Scholar
  11. 11.
    Roux FX, Nataf F, Pinaudeau M, et al. Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol. 1996;46:458–64.CrossRefPubMedGoogle Scholar
  12. 12.
    McCormick P. Surgical management of dumbbell tumors of the thoracic and lumbar spine. Neurosurgery. 1996;38:67–74.CrossRefPubMedGoogle Scholar
  13. 13.
    McCormick P. Surgical management of dumbbell tumors of the cervical spine. Neurosurgery. 1996;38:294–300.CrossRefPubMedGoogle Scholar
  14. 14.
    Parsa A, Lee J, Parney I, et al. Spinal cord and intraductal-extraparenchymal spine tumors: current base care practices and strategies. J Neurooncol. 2004;69:219–318.CrossRefGoogle Scholar
  15. 15.
    Asazuma T, Toyama Y, Maruiwa H, et al. Surgical strategy for cervical dumbbell tumors based on a three-dimensional classification. Spine. 2004;29:E10–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Klekamp J, Samii M. Surgical results for spinal meningiomas. Surg Neurol. 1999;52:552–62.CrossRefPubMedGoogle Scholar
  17. 17.
    Levy WJ Jr, Bay J, Dohn D. Spinal cord meningioma. J Neurosurg. 1982;57:804–12.CrossRefPubMedGoogle Scholar
  18. 18.
    Schick U, Marquardt G, Lorenz R. Recurrence of benign spinal neoplasms. Neurosurg Rev. 2001;24:20–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Mirimanoff R, Dosretz D, Lingood R, et al. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg. 1985;62:18–24.CrossRefPubMedGoogle Scholar
  20. 20.
    Dodd RL, Ryu MR, Kamnerdsupaphon P, et al. CyberKnife radiosurgery for benign intradural extramedullary spinal tumors. Neurosurgery. 2006;58(4):674–85.CrossRefPubMedGoogle Scholar
  21. 21.
    Gerszten PC, Chen S, Quader M, et al. Radiosurgery for benign tumors of the spine using the Synergy S with cone-beam computed tomography image guidance. J Neurosurg. 2012;117(Suppl):197–202.PubMedGoogle Scholar
  22. 22.
    Gerszten PC, Quader M, Novotny J Jr, et al. Radiosurgery for benign tumors of the spine: clinical experience and current trends. Technol Cancer Res Treat. 2012;11(2):133–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Gerszten PC, Burton SA, Ozhasoglu C, et al. Radiosurgery for benign intradural spinal tumors. Neurosurgery. 2008;62(4):887–95.CrossRefPubMedGoogle Scholar
  24. 24.
    Nabors LB, Portnow J, Ammirati M, et al. Central nervous system cancers, version 1.2015. J Natl Compr Cancer Netw. 2016;13(10):1191–202.CrossRefGoogle Scholar
  25. 25.
    Gibbs I, Chang S, Dodd R, et al. Radiosurgery for benign extramedullary tumors of the spine. In: Gerszten P, Ryu S, editors. Spine radiosurgery. New York: Thieme; 2015.Google Scholar
  26. 26.
    Gerszten P. The role of minimally invasive techniques in the management of spine tumors: percutaneous bone cement augmentation, radiosurgery, and microendoscopic approaches. Orthop Clin North Am. 2007;38:441–50.CrossRefPubMedGoogle Scholar
  27. 27.
    De Salles AA, Pedroso AG, Medin P, et al. Spinal lesions treated with Novalis shaped beam intensity-modulated radiosurgery and stereotactic radiotherapy. J Neurosurg. 2004;101(Suppl 3):435–40.PubMedGoogle Scholar
  28. 28.
    Benzil DL, Saboori M, Mogilner AY, et al. Safety and efficacy of stereotactic radiosurgery for tumors of the spine. J Neurosurg. 2004;101(Suppl 3):413–8.PubMedGoogle Scholar
  29. 29.
    Sahgal A, Chou D, Ames C, et al. Image-guided robotic stereotactic body radiotherapy for benign spinal tumors: The University of California San Francisco preliminary experience. Technol Cancer Res Treat. 2007;6:595–604.CrossRefPubMedGoogle Scholar
  30. 30.
    Sachdev S, Dodd RL, Chang SD, et al. Stereotactic radiosurgery yields long-term control for benign intradural, extramedullary spinal tumors. Neurosurgery. 2011;69(3):533–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Yamada Y, Lovelock DM, Bilsky MH. A review of image-guided intensity-modulated radiotherapy for spinal tumors. Neurosurgery. 2007;61(2):226–35.CrossRefPubMedGoogle Scholar
  32. 32.
    Gerszten P, Bilsky MH. Spine radiosurgery. Contemp Neurosurg. 2006;28:1–8.CrossRefGoogle Scholar
  33. 33.
    Gibbs IC, Patil C, Gerszten PC, et al. Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery. 2009;64(2 Suppl):A67–72.CrossRefPubMedGoogle Scholar
  34. 34.
    Rampling R, Symonds P. Radiation myelopathy. Curr Opin Neruol. 1998;11:627–32.CrossRefGoogle Scholar
  35. 35.
    Isaacson S. Radiation therapy and the management of intramedullary spinal cord tumors. J Neurooncol. 2000;47:231–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nima Alan
    • 1
  • John C. Flickinger
    • 2
  • Peter Carlos Gerszten
    • 1
    • 3
  1. 1.Department of Neurological SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Department of Radiation Oncology, UPMC Presbyterian-Shadyside HospitalUniversity of Pittsburgh School of MedicinePittsburghUSA
  3. 3.Department of Radiation OncologyUniversity of Pittsburgh Medical CenterPittsburghUSA

Personalised recommendations