Risk factors for nonresolving neurological deficits after spinal meningioma surgery: an integrated clinical and volumetric analysis of 202 patients.

Abstract

Functional outcome after resection of spinal meningiomas (SMs) is mostly considered satisfactory. However, patients with nonresolving neurological symptoms show a reduced quality of life. This study examined factors that determine full neurological recovery after resection of SMs. A single-center retrospective analysis of consecutive patients undergoing surgery on SM between 2007 and 2022 integrated clinical and surgical data with MRI-based automated volumetric tumor analyses. Patients with a favorable outcome (Frankel grade E) were compared to patients with nonresolving neurological symptoms (Frankel grade A-D) at final follow-up. A total of 202 patients with a histologically diagnosed SM were included. The cohort consisted of 159 females (78.7%) and had a median age of 65 (interquartile range [IQR] 55-74) years. Upon admission, clinical examination in 97 patients (48.0%) revealed a Frankel grade of A-D. Gross-total resection was achieved in 193 patients (95.5%) with a surgical complication rate of 8.9% (n = 18). After a median follow-up of 479 (IQR 193-1049) days, 135 patients (66.8%) showed intact neurological function (Frankel grade E). A univariate analysis revealed an overrepresentation of advanced age (OR for age ≤ 60 years = 0.14, p < 0.0001) and higher rates of preoperative neurological deficits (OR 7.39, p < 0.0001) in patients without complete recovery. No significant differences were noted in tumor volume between both groups (mean 2.34 [SD 1.69] vs 2.36 [SD 1.75] cm3, p = 0.962). In a multivariate analysis, age > 60 years, preoperative Frankel grade A-D, and Ki-67/MIB-1 index < 5% were significantly associated with nonresolving deficits at the final follow-up. This volumetry-informed series of patients with SM revealed older age and a low Ki-67 index, along with preoperative neurological deficits, constitute a higher risk of nonresolving neurological symptoms after resection. An early surgical intervention in oligosymptomatic young patients could therefore help preserve excellent long-term neurological function.