title: Factors Leading to a Poor Functional Outcome in Spinal Meningioma Surgery: Remarks on 173 Cases.
abstract: Spinal meningiomas are common spinal tumors, in most cases benign and with a good surgical prognosis. However, specific location, infiltration of spinal cord, vascular encasement, or spinal root involvement can bring a less favorable prognosis.
  
  
  
  To correlate these data with clinical/functional outcome.
  
  
  
  Two hundred twenty-four consecutive patients with spinal meningiomas treated from 1976 to 2013 in our institution were analyzed; among these, 51 were excluded for incomplete clinical data or follow-up. The remaining 173 cases were classified in regards to sex, age, symptoms, axial location, Simpson grade resection, and functional pre-/postoperative status.
  
  
  
  Most recurring onset symptoms were pain (32.9%) and motor deficit (31.8%); thoracic spine was the most severely affected (69.8%). Functional improvement on the follow-up was observed in 86.7% of cases; 6.4% of patients resulted stable and 6.9% worsened. A low functional grade before surgery was connected to a lesser improvement after. Anterolateral meningiomas were the most represented (42.2%); a gross total resection (Simpson grades I and II) was conducted in 98.8%, and a macroscopically complete removal without dural resection or coagulation (Simpson grade III) was performed in 1.2%. Of the meningiomas, 98.3% were classified as WHO grade I. Recurrence rate was 2.3%, and 7 cases presented complications (4 of 7 required surgical procedure).
  
  
  
  We can affirm that negative prognostic factors in our study were anterior or anterolateral axial location, prolonged presentation before diagnosis, WHO grade >I, Simpson grade resections II and III, sphincter involvement, and worse functional grade at onset.
authors.affiliation: Neurosurgery Division, NESMOS Department, Sapienza University, Roma, Italy.|Azienda Ospedaliera Sant'Andrea, Roma, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Raco
authors.affiliation: Azienda Ospedaliera Sant'Andrea, Roma, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pesce
authors.affiliation: Azienda Ospedaliera Sant'Andrea, Roma, Italy.
authors.forename: Giada
authors.initials: G
authors.lastname: Toccaceli
authors.affiliation: Neurosurgery Division, NESMOS Department, Sapienza University, Roma, Italy.|Policlinico Umberto I, Roma, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Domenicucci
authors.affiliation: Neurosurgery Division, NESMOS Department, Sapienza University, Roma, Italy.|Santa Maria Goretti Hospital, Latina, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Miscusi
authors.affiliation: Neurosurgery Division, NESMOS Department, Sapienza University, Roma, Italy.|Policlinico Umberto I, Roma, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Delfini
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D019635:Neurosurgical Procedures; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Extramedullary; Intradural; Meningioma; Spinal cord; Spine; Tumors