Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Selection and Study Setting
2.2. Surgical Technique and Follow-Up Routine
2.3. Variables
2.4. Statistics
3. Results
3.1. Baseline and Treatment Data
3.2. Outcome Data
3.3. Functional Outcome
3.4. Elderly vs. Non-Elderly Patients
3.5. Predictors of Improved Functional Outcome
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ASA | American Society of Anesthesiologists |
mMCs | modified McCormick scale |
MRI | magnetic resonance imaging |
OR | odds ratio |
WHO | World Health Organization |
References
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Grade | Explanation |
---|---|
1 | Intact neurologically, normal ambulation, minimal dysesthesia |
2 | Mild motor or sensory deficit, functional independence |
3 | Moderate deficit, limitation of function, independent w/external aid |
4 | Severe motor or sensory deficit, limited function, dependent |
5 | Paraplegia or quadriplegia, even w/flickering movement |
Variables | All Patients (n = 129) | Elderly (n = 46) | Non-Elderly (n = 83) | p-Value |
---|---|---|---|---|
Age (years) | 65 (23–94) | 76 (70–94) | 58 (23–69) | - |
Male sex | 23 (18%) | 10 (22%) | 13 (16%) | 0.388 |
ASA class | 2 (1–3) | 3 (2–3) | 2 (1–3) | 0.023 |
Prior radiotherapy | 2 (1.6%) | 0 (0%) | 2 (2.4%) | - |
Prior spinal surgery | 1 (0.8%) | 1 (2.2%) | 0 (0%) | - |
Concurrent cranial meningioma | 8 (6%) | 2 (4%) | 6 (7%) | - |
Neurofibromatosis type 2 | 1 (0.8%) | 0 (0%) | 1 (1.2%) | - |
Neurological deficits | ||||
Motor deficit | 85 (66%) | 36 (78%) | 49 (59%) | 0.027 |
Sensory deficit | 82 (64%) | 35 (76%) | 47 (57%) | 0.028 |
Gait disturbance | 79 (61%) | 35 (76%) | 44 (53%) | 0.010 |
Bladder dysfunction | 45 (35%) | 16 (35%) | 29 (35%) | 0.986 |
Pain | 66 (51%) | 19 (41%) | 47 (57%) | 0.095 |
Modified McCormick scale (mMCs) | 2 (1–4) | 3 (1–4) | 2 (1–4) | <0.001 |
mMCs 1 | 33 (26%) | 7 (15%) | 26 (31%) | - |
mMCs 2 | 47 (36%) | 11 (24%) | 36 (43%) | - |
mMCs 3 | 37 (29%) | 21 (46%) | 16 (19%) | - |
mMCs 4 | 12 (9.3%) | 7 (15%) | 5 (6.0%) | - |
mMCs 5 | 0 (0%) | 0 (0%) | 0 (0%) | - |
Tumor level | ||||
Cervical | 39 (30%) | 12 (26%) | 27 (33%) | 0.445 |
Thoracic | 89 (69%) | 34 (74%) | 55 (66%) | - |
Lumbar | 1 (0.8%) | 0 (0%) | 1 (1.2%) | - |
Anterior tumor component | 30 (23%) | 14 (30%) | 16 (19%) | 0.151 |
Tumor area (cm2) | 1.4 (0.2–4.5) | 1.4 (0.4–3.1) | 1.4 (0.2–4.5) | 0.689 |
Spinal cord compression (%) | 69 (12–89) | 69 (20–89) | 69 (12–89) | 0.303 |
Variable | All Patients (n = 129) | Elderly (n = 46) | Non-Elderly (n = 83) | p-Value |
---|---|---|---|---|
Time from diagnosis to surgery (months) | 1.3 (0.03–36) | 0.5 (0.03–36) | 1.8 (0.03–30) | 0.005 |
Laminectomy range (levels) | 3 (1–6) | 3 (1–6) | 2 (1–5) | 0.803 |
Laminoplasty | 35 (27%) | 9 (20%) | 26 (31%) | 0.150 |
Simpson grade | ||||
Simpson grade 1 | 0 (0%) | 0 (0%) | 0 (0%) | - |
Simpson grade 2 | 92 (71%) | 32 (70%) | 60 (72%) | 0.743 |
Simpson grade 3 | 17 (13%) | 6 (13%) | 11 (13%) | 0.973 |
Simpson grade 4 | 20 (16%) | 8 (17%) | 12 (14%) | 0.194 |
Simpson grade 5 | 0 (0%) | 0 (0%) | 0 (0%) | - |
Histopathological data | ||||
Meningioma WHO grade 1 | 127 (98%) | 45 (98%) | 82 (99%) | 0.670 |
Meningioma WHO grade 2 | 2 (1.5%) | 1 (2.2%) | 1 (1.2%) | - |
Meningioma WHO grade 3 | 0 (0%) | 0 (0%) | 0 (0%) | - |
MIB1-index (%) | 4.5 (0–20) | 4.8 (1.0–20) | 4.0 (0–15) | 0.944 |
Postoperative radiotherapy | 1 (0.8%) | 1 (2.2%) | 0 (0%) | - |
Postoperative chemotherapy | 0 (0%) | 0 (0%) | 0 (0%) | - |
Variable | All Patients (n = 129) | Elderly (n = 46) | Non-Elderly (n = 83) | p-Value |
---|---|---|---|---|
Time to initial follow-up (months) | 4.6 (2.7–10) | 4.7 (3.2–9.2) | 4.4 (2.7–9.8) | 0.516 |
Long-term follow-up time (years) | 8.2 (0.3–16) | 6.8 (0.3–16) | 8.6 (3.1–16) | 0.117 |
Postoperative complication | 10 (7.8%) | 1 (0.8%) | 9 (11%) | 0.077 |
Tethered spinal cord | 1 | 1 | 0 | - |
Wound infection | 3 | 0 | 3 | - |
Pneumonia | 1 | 0 | 1 | - |
Cerebrospinal fluid leak | 2 | 0 | 2 | - |
Kyphosis | 2 | 0 | 2 | - |
Myocardial infarction | 1 | 0 | 1 | - |
Reoperation | 4 (3.1%) | 2 (4.3%) | 2 (2.4%) | 0.543 |
Tethered spinal cord | 1 | 1 | 0 | - |
Tumor resection (local tumor recurrence) | 2 | 1 | 1 | - |
Wound revision (infection) | 1 | 0 | 1 | - |
Tumor growth/recurrence | 6 (4.7%) | 1 (2.2%) | 5 (6.0%) | 0.320 |
Local recurrence | 2 | 1 | 1 | - |
Local progression | 4 | 0 | 4 | - |
Change in mMCs | 0 (−1–3) | 0.5 (0–2) | 0 (−1–3) | 0.629 |
Improved | 61 (47%) | 23 (50%) | 38 (46%) | 0.646 |
Unchanged | 66 (51%) | 23 (50%) | 43 (52%) | 0.844 |
Worse | 2 (1.6%) | 0 (0%) | 2 (2.4%) | - |
Mortality | ||||
3-month mortality | 0 (0%) | 0 (0%) | 0 (0%) | - |
Long-term mortality | 27 (21%) | 22 (48%) | 5 (6.0%) | <0.001 |
Tumor-related death | 1 (1%) | 1 (2%) | 0 (0%) | - |
Years from surgery to death | 6.6 (0.3–15) | 5.9 (0.3–15) | 8.5 (3.1–12) | - |
Postoperative Change | Motor | Sensory | Gait | Bladder | Pain |
---|---|---|---|---|---|
Patients with preoperative deficit (n) | 85 | 82 | 79 | 45 | 66 |
Completely resolved | 39 (46%) | 38 (46%) | 40 (51%) | 34 (76%) | 35 (53%) |
Unchanged/partial improvement | 46 (54%) | 44 (54%) | 39 (49%) | 11 (24%) | 31 (47%) |
Worse (increased deficit) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
Worse (new deficit) | 2 | 4 | 2 | 2 | 9 |
p-value (paired testing) | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 |
Variable | p-Value | OR (95% CI) | Nagelkerke’s R2 |
---|---|---|---|
Elderly | 0.646 | - | |
Male sex | 0.330 | - | |
ASA class ≥ 3 | 0.589 | - | |
Months to surgery | 0.005 | 0.86 (0.76–0.94) | 0.141 |
Cervical tumor | 0.830 | - | |
Anterior tumor | 0.734 | - | |
Tumor area (cm2) | 0.030 | 1.73 (1.00–3.17) | 0.053 |
Spinal cord compression (%) | <0.001 | 1.03 (1.01–1.06) | 0.137 |
MIB1-index | 0.053 | - | |
Simpson grade ≥ 3 | 0.690 | - |
Variable | p-Value |
---|---|
Included in final step-down model | |
Spinal cord compression | 0.002 |
Not included in final step-down model | |
Months to surgery | >0.05 |
Tumor area | >0.05 |
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Pettersson-Segerlind, J.; Fletcher-Sandersjöö, A.; Tatter, C.; Burström, G.; Persson, O.; Förander, P.; Mathiesen, T.; Bartek, J., Jr.; Edström, E.; Elmi-Terander, A. Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study. Cancers 2021, 13, 3244. https://doi.org/10.3390/cancers13133244
Pettersson-Segerlind J, Fletcher-Sandersjöö A, Tatter C, Burström G, Persson O, Förander P, Mathiesen T, Bartek J Jr., Edström E, Elmi-Terander A. Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study. Cancers. 2021; 13(13):3244. https://doi.org/10.3390/cancers13133244
Chicago/Turabian StylePettersson-Segerlind, Jenny, Alexander Fletcher-Sandersjöö, Charles Tatter, Gustav Burström, Oscar Persson, Petter Förander, Tiit Mathiesen, Jiri Bartek, Jr., Erik Edström, and Adrian Elmi-Terander. 2021. "Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study" Cancers 13, no. 13: 3244. https://doi.org/10.3390/cancers13133244