title: Complication avoidance in the resection of spinal meningiomas.
abstract: BACKGROUND
  Surgical resection is considered the treatment of choice for spinal meningiomas and can be safe and effective; however, neurologic and surgical complications occur. This article reviews the factors that may predict susceptibility to this postoperative decline and addresses therapeutic choices, adjunctive therapies, and technologic applications that may help avoid complications.
  
  
  METHODS
  A literature search was conducted for articles related to spinal meningiomas addressing surgical treatment, adjuvant treatment, and technologic applications related to management and minimizing of complications.
  
  
  RESULTS
  There were 16 surgical series identified, comprising 1090 patients with median mortality of 1% (range, 0%-4%), nonneurologic surgical morbidity of 4% (range, 0%-24%), and permanent neurologic deterioration of 6% (range, 0%-21%). Common complications were cerebrospinal fluid leaks and fistulas, venous thromboembolic disease, myocardial infarction, and neurologic deterioration with either transient or permanent neurologic deficits. Predictive risk factors of neurologic decline included pathoanatomic features of lesion calcification, anterior dural attachment, infiltrative tumor, and tumoral adherence to the spinal cord and patient-specific factors of preoperative neurologic and advanced age.
  
  
  CONCLUSIONS
  Alongside surgery, selection of more direct approaches and use of adjuvant radiotherapy in patients with higher grade lesions and recurrent disease may lead to improved outcomes. New technologies, including microsurgical technique, intraoperative electrophysiologic monitoring, intraoperative ultrasound, and ultrasonic aspiration, may improve the safety and limit the complications of resection.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada.
authors.forename: Harrison J
authors.initials: HJ
authors.lastname: Westwick
authors.affiliation: Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Sung-Joo
authors.initials: SJ
authors.lastname: Yuh
authors.affiliation: Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: mohammed.shamji@uhn.ca.
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Shamji
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D008579:Meningioma / Q000601:surgery*; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000517:prevention & control*; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D013125:Spinal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Complication; Meningioma; Spinal meningioma; Surgery