Post-Doctoral Neurosurgery Research Fellow Johns Hopkins University Johns Hopkins University School of Medicine Baltimore, MD, US
Disclosure(s):
Abdel-Hameed Al-Mistarehi, MD: No financial relationships to disclose
Introduction: The size of spinal meningiomas is often incongruous with associated symptoms. Further, these lesions do not exhibit uniform rates of growth. Therefore, the decision to pursue surgery before symptoms develop, namely weakness, can be challenging. This study aims to identify the impact of tumor volume on symptoms before and after surgery for spinal meningiomas.
Methods: Adult patients treated for spinal meningiomas at a tertiary care center from 2009-2023 with ≥1 preoperative MRI housed in the local PACS system were retrospectively collected. Tumor volumes were measured using local PACS software. Patient demographic information, clinical data including symptoms at each MRI, and any deficits across multiple postoperative timeframes were collected. Welch two-sample t-tests evaluated differences in volumes among preoperative symptoms. Receiver Operating Curves (ROCs) then evaluated for volume thresholds and Fisher’s exact odds ratios clarified relationships between pertinent thresholds and neurological deficits.
Results: 91 patients met criteria and 86.8% were women. Average age at time of surgery was 63±14 years old and postoperative followup was 4.4±3.3 years. The most common preoperative symptoms were sensory deficits (61.5%), axial pain (60.4%), and weakness (49.5%). The average time from last MRI to surgery was 52.5±46.1 days and tumors were 2.0±1.2cm3. Those with preoperative weakness had larger tumors than those without (2.25±1.22cm3 vs 1.73±1.16cm3, p=0.020). Notably, lesions ≥1.6cm3 (AUC 0.670, Accuracy 0.642, 95% CI 0.531-0.745) demonstrated a higher risk of motor deficits in the preoperative, postoperative 4-12 month, and last follow-up timeframes (preoperative OR 3.9, 95% CI 1.53-10.64, p=0.004; postoperative 4-12 month OR 6.1, 95% CI 1.66-30.88, p=0.008; last follow-up OR 5.0, 95% CI 1.05-40.64, p=0.044).
Conclusion : Spinal meningiomas should be resected when symptomatic or growing and understanding the risk profile, particularly for larger tumors (>1.6cm3), can be helpful in patient counseling.
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