Spinal meningioma epidemiology

Spinal meningioma epidemiology

Because spinal meningiomas are infrequently encountered in any one center, a large portion of the literature relating to spinal meningiomas consists of case reports or case series 1)


In The Surveillance, Epidemiology and End Results, the age-adjusted incidence rate was 0.37 cases per 1,000,000 person-years between 2004 and 2016. Spinal meningiomas represented 4.25% of all meningiomas. A total of 4204 patients with spinal meningiomas were included in the study. Most of the patients were white and diagnosed at 60-69 years of age, and the female:male ratio was 4:1. Most of the tumors were benign and less than 3 cm in size. The most common pathological type was psammomatous meningioma. Surgery was the first choice of treatment for patients with spinal meningiomas. Male and pediatric patients were more vulnerable to borderline or malignant spinal meningiomas. Survival analysis showed that married, female, and younger patients with benign meningiomas had better overall survival than their counterparts 2).


Approximately 1000 spinal meningiomas were diagnosed in the United States per year, and the incidence was relatively stable. Advanced age, female sex, Asian Pacific Islander and Caucasian race, and Hispanic ethnicity were all associated with an increased incidence of spinal meningioma. The study of represents the most comprehensive evaluation of population-based descriptive epidemiology of spinal meningiomas in the United States to date 3).


Spinal meningiomas represent a significant fraction of all primary intradural spinal tumors and of all meningiomas. The results of a study of Westwick and Shamji established the association of lesion incidence and survival with sex, with a less frequent incidence in but greater mortality among males 4).

Meningiomas arising from the coverings of the spinal cord are one of the two most common intradural extramedullary spinal tumors, representing 25-30% of all such tumor5)

Amongst the intraspinal location, meningiomas account for 25% to 46% of primary spinal neoplasms, while the incidence of spinal meningiomas is 7.5% to 12.7% of all meningiomas

They have a peak incidence in the fifth and sixth decades. Interestingly, and unlike intracranial meningiomas, in the adult population, females are approximately ten times more commonly affected than males. In children, there does not appear to be a sex predilection.

There is an increased incidence of spinal meningiomas in patients with neurofibromatosis type 2 (NF2), and in fact in the paediatric population, meningiomas uncommonly occur outside of the setting of NF2.


Except in cases of neurofibromatosis, it is very rare for tumors of different pathological types to exist concurrently at the same spinal level, with only 9 cases reported to date, in which spinal meningioma was found with spinal schwannoma in 7 cases and with spinal neurofibroma in 2 cases 6).


2)

Cao Y, Jiang Y, Liu C, Jin R, Jin Z, Hong X, Zhao L, Zhao G, Wang Y. Epidemiology and survival of patients with spinal meningiomas: A SEER analysis. Eur J Surg Oncol. 2021 Jan 22:S0748-7983(21)00039-1. doi: 10.1016/j.ejso.2021.01.012. Epub ahead of print. PMID: 33546961.
3)

Kshettry VR, Hsieh JK, Ostrom QT, Kruchko C, Benzel EC, Barnholtz-Sloan JS. Descriptive Epidemiology of Spinal Meningiomas in the United States. Spine (Phila Pa 1976). 2015 Aug 1;40(15):E886-9. doi: 10.1097/BRS.0000000000000974. PMID: 25996535.
4)

Westwick HJ, Shamji MF. Effects of sex on the incidence and prognosis of spinal meningiomas: a Surveillance, Epidemiology, and End Results study. J Neurosurg Spine. 2015 Sep;23(3):368-73. doi: 10.3171/2014.12.SPINE14974. Epub 2015 May 29. PMID: 26023898.
5)

Osborn AG. Diagnostic neuroradiology. Mosby Inc. (1994) ISBN:0801674867.
6)

Zhan Z, Yan X, Nie W, Ding Y, Xu W, Huang H. Neurofibroma and Meningioma within a Single Dumbbell-Shaped Tumor at the Same Cervical Level without Neurofibromatosis: a Case Report and Literature Review. World Neurosurg. 2019 Jun 26. pii: S1878-8750(19)31788-7. doi: 10.1016/j.wneu.2019.06.142. [Epub ahead of print] PubMed PMID: 31254713.

Meningioma

Meningioma

Meningiomas are leptomeningeal neoplasms thought to originate from arachnoid membranes that form the cranial and spinal meninge1).

Written with Louise Eisenhardt and published in 1938Meningiomas is a monograph of incredible description and detail. The meticulous categorization of meningiomas, their presentation, clinical outcome, and surgical therapies are even further supplemented by Cushing‘s personal commentary, questions, and recollections. Cushing’s genius was evident in his ability not only to make insightful clinical observations, but also to synthesize these ideas within the neurosurgical context of his era. As he says in Meningiomas, “Thus the pathological curiosity of one day becomes in its proper time a commonplace… most of which are one and the same disorder–had, for their interpretation, to await the advent of the Neurosurgeon 2).

Meningioma epidemiology.

see Meningioma classification.

see Meningioma cell lines.

see Meningioma etiology.

see Meningioma Pathogenesis.

Meningioma clinical features

see Asymptomatic meningioma

see Meningioma Diagnosis.

see Meningioma differential diagnosis.

see Meningioma treatment.

see Meningioma outcome.

see Meningioma recurrence.

see Simpson grading system.

In November 2016, Almutairi et al. performed a title-specific search of the Scopus database using “Meningioma” as the search query term without publication date restrictions. The top 100 most cited articles were obtained and reviewed.

The top 100 most cited articles received a mean 198 citations per paper. Publication dates ranged from 1953 to 2013; most articles were published between 1994 and 2003, with 50 articles published during that period. NEUROSURGERY published the greatest number of top cited articles (22 of 100). The most frequent study categories were laboratorial studies (31 of 100) and natural history studies (28 of 100). Non-operative management studies were twice as common as operative management studies in the top cited articles. Neurosurgery as a specialty contributed to 50% of the top 100 list. The most contributing institute was the Mayo Clinic (11%); the majority of the top cited articles originated in the United States (53%).

They identified the top 100 most-cited articles on meningioma that may be considered significant and impactful works, as well as the most noteworthy. Additionally, they recognized the historical development and advances in meningioma research, and the important contributions of various authors, specialty fields, and countries. A large proportion of the most cited articles were written by authors other than neurosurgeons, and many of these articles were published in non-neurosurgery journals 3).

Meningioma case series.


1)

Smith MJ, O’Sullivan J, Bhaskar SS, Hadfield KD, Poke G, Caird J, Sharif S, Eccles D, Fitzpatrick D, Rawluk D, du Plessis D, Newman WG, Evans DG. Loss-of-function mutations in SMARCE1 cause an inherited disorder of multiple spinal meningiomas. Nat Genet. 2013 Mar;45(3):295-8. doi: 10.1038/ng.2552. Epub 2013 Feb 3. PubMed PMID: 23377182.
2)

Shrivastava RK, Segal S, Camins MB, Sen C, Post KD. Harvey Cushing’s Meningiomas text and the historical origin of resectability criteria for the anterior one third of the superior sagittal sinus. J Neurosurg. 2003 Oct;99(4):787-91. PubMed PMID: 14567620.
3)

Almutairi O, Albakr A, Al-Habib A, Ajlan A. The Top 100 Most Cited Articles on Meningioma. World Neurosurg. 2017 Aug 10. pii: S1878-8750(17)31318-9. doi: 10.1016/j.wneu.2017.08.021. [Epub ahead of print] Review. PubMed PMID: 28804043.

Skull base meningioma outcome

Skull base meningioma outcome

Peritumoral edema (PTE) in skull base meningiomas correlates to the absence of an arachnoid plane and difference in outcome.

A subset of benign (WHO grade I) skull base meningiomas shows early progression/recurrence (P/R) in the first years after surgical resection.


Though various predictors of adverse postoperative outcomes among meningioma patients have been established, research has yet to develop a method for consolidating these findings to allow for predictions of adverse healthcare outcomes for patients diagnosed with skull base meningiomas.


The objective of a study was to develop three predictive algorithms that can be used to estimate an individual patient’s probability of extended length of stay (LOS), experiencing a nonroutine discharge disposition, or incurring high hospital charges following surgical resection of a skull base meningioma.

The study utilized data from patients who underwent surgical resection for skull base meningiomas at a single academic institution between 2017-2019. Multivariate logistic regression analysis was used to predict extended LOS, nonroutine discharge, and high hospital charges, and 2000 bootstrapped samples were used to calculate an optimism-corrected c-statistic. The Hosmer-Lemeshow test was used to assess model calibration, and p<0.05 was considered statistically significant.

A total of 245 patients were included in our analysis. Our cohort was majority female (77.6%) and Caucasian (62.4%). Our models predicting extended LOS, nonroutine discharge, and high hospital charges had optimism-corrected c-statistics of 0.768, 0.784, and 0.783, respectively. All models demonstrated adequate calibration (p>0.05), and were deployed an open-access, online calculator: https://neurooncsurgery3.shinyapps.io/high_value_skull_base_calc/.

Following external validation, these predictive models have the potential to aid clinicians in providing patients with individualized risk-estimation for healthcare outcomes following meningioma surgery 1).


Ko et al. retrospectively investigated the preoperative CT and MR imaging features for the prediction of P/R in skull base meningiomas, with emphasis on quantitative ADC values. Only patients had postoperative MRI follow-ups for more than 1 year (at least every 6 months) were included. From October 2006 to December 2015, total 73 patients diagnosed with benign (WHO grade I) skull base meningiomas were included (median follow-up time 41 months), and 17 (23.3%) patients had P/R (median time to P/R 28 months). Skull base meningiomas with spheno-orbital location, adjacent bone invasion, high DWI, and lower ADC value/ratio were significantly associated with P/R (P < 0.05). The cut-off points of ADC value and ADC ratio for prediction of P/R are 0.83 × 10- 3 mm2/s and 1.09 respectively, with excellent area under curve (AUC) values (0.86 and 0.91) (P < 0.05). In multivariate logistic regression, low ADC values (< 0.83 × 10- 3 mm2/s) and adjacent bone invasion are high-risk factors of P/R (P < 0.05), with odds ratios of 31.53 and 17.59 respectively. The preoperative CT and MRI features for prediction of P/R offered clinically vital information for the planning of treatment in skull base meningiomas 2).


1)

Jimenez AE, Khalafallah AM, Lam S, Horowitz MA, Azmeh O, Rakovec M, Patel P, Porras JL, Mukherjee D. Predicting High-Value Care Outcomes Following Surgery for Skull Base Meningiomas. World Neurosurg. 2021 Feb 7:S1878-8750(21)00188-1. doi: 10.1016/j.wneu.2021.02.007. Epub ahead of print. PMID: 33567369.
2)

Ko CC, Lim SW, Chen TY, Chen JH, Li CF, Shiue YL. Prediction of progression in skull base meningiomas: additional benefits of apparent diffusion coefficient value. J Neurooncol. 2018 Jan 20. doi: 10.1007/s11060-018-2769-9. [Epub ahead of print] PubMed PMID: 29353434.
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