Minimally invasive surgery for intradural spinal meningioma: A new standard? A comparative study between minimally invasive and open approaches.

BACKGROUND: Some authors used minimally invasive surgery (MIS) in the treatment of spinal cord tumor, but these studies had a small sample sizes and mixed extra- and intra-medullary tumors, resulting in confounding biases. The objectives of the present study were to evaluate the effectiveness and safety of MIS for spinal meningioma resection in comparison with open surgery (OS). METHODS: Consecutive patients with spinal meningioma who received either MIS or OS were included. Data for extent of resection, functional outcome, postoperative morbidity and recurrence were collected. RESULTS: A total of 48 patients (with 51 spinal meningiomas) were included. Eighteen underwent MIS and 30 OS. Meningioma volume and location did not differ significantly between groups: tumors were predominantly thoracic (n=39, 76.5%) and voluminous (occupying more than 50% of the spinal canal: n=43, 84.3%). In the MIS group, patients were older (mean age: 66.5 vs. 56.4years, P=0.02) and more fragile (mean ASA score: 2.0 vs. 1.6, P=0.06). In the MIS group, the surgical procedure was shorter (mean duration: 2.07 vs. 2.56h, P=0.04), blood loss lower (mean: 252 vs. 456mL, P=0.02), and hospital stay shorter (mean: 6.6 vs. 8.1days). Surgery improved the modified McCormick scale (P<0.0001) irrespective of the surgical technique. MIS led to no significant differences in extent of resection or postoperative morbidity. Mean follow-up was 46.6 months. At last follow-up, 91.7% (n=44) of patients were free of progression; all cases of tumor progression (n=4) occurred in the OS group. CONCLUSIONS: MIS outperformed OS in the management of intradural spinal meningioma, irrespective of location and volume. MIS appears to be particularly suitable for elderly and fragile patients.

Prognostic factors for progression-free survival of the filum terminale ependymomas in adults.

OBJECTIVE: To define the prognostic factors for progression and to determine the impact of the histological grading (according to the World Health Organization) on the progression-free survival (PFS) of filum terminale ependymomas. METHODS: A retrospective chart review of 38 patients with ependymoma of the filum terminale was performed, focusing on demographic data, preoperative symptoms, tumor size, quality of resection, presence of a tumor capsule, and histological grade. RESULTS: Gross total resection (GTR) was achieved in 30 patients (78.9%). Histopathological analysis found 21 (55.3%) myxopapillary grade I ependymoma (MPE), 16 (42.1%) ependymoma grade II (EGII), and 1 (2.6%) ependymoma grade III. There was no significant difference between the mean±SD volume of MPE (5840.5±5244.2mm3) and the one of EGII (7220.3±6305.9mm3, p=0.5). The mean±SD follow-up was 54.1±38.4 months. At last follow-up, 30 (78.9%) patients were free of progression. In multivariate analysis, subtotal resection (p=0.015) and infiltrative tumor (p=0.03) were significantly associated with progression. The PFS was significantly higher in patients with encapsulated tumor than in patients with infiltrative tumor (log-rank p=0.01) and in patients who had a GTR in comparison with those who had an incomplete resection (log-rank p=0.05). There was no difference in PFS between patient with MPE and EGII (p=0.1). CONCLUSION: The progression of ependymoma of the filum terminale highly depends on the quality of resection, and whether the tumor is encapsulated. Except for anaplastic grade, histopathological type does not influence progression.

How to differentiate spinal cord hemangiopericytoma from common spinal cord tumor?

INTRODUCTION: Tumors of the spinal cord are rare and some can be confused with each other. We report a rare spinal cord solitary fibrous tumor/hemangiopericytoma (SFT/HPC), and propose keys to differentiate spinal cord tumors from each other. CASE REPORT: A 67-year-old man presented weakness with recent diffuse sensory disorders in the right lower limb. Spinal MRI revealed a T8-T9 intradural extramedullary mass with spinal cord compression. Gross total resection of a poorly vascularized intradural tumor was achieved. It was an encapsulated extramedullary tumor, which was difficult to separate from the spinal cord due to the presence of pial adhesions. Definitive diagnosis was grade 1 SFT/HPC of the spinal cord. One-year follow-up MRI revealed complete excision without any evidence of residual tumor. CONCLUSION: SFT/HPC is a very rare spinal tumor that can be extramedullary, intramedullary or both. It may perfectly mimic meningioma. The maximal resection is the best treatment, but can be challenging because of the tumor's firm consistency and pial adherences to the spinal cord. Outcome is good in case of gross total resection, but there is a risk of very late recurrence, requiring long-term follow-up.

Subdural hematoma and electroconvulsive therapy: A case report and review of the literature.

BACKGROUND AND CASE PRESENTATION: Electroconvulsive therapy (ECT) is a common therapeutic procedure in psychiatry associated with a low rate of complications. We report a rare case of subdural hematoma (SDH) associated with ECT. CLINICAL PRESENTATION: a 64 year old woman, with a medical history of persistent depression which required ECT six years previously, underwent ECT following a new acute episode. After four ECT sessions, a left hemiparesis occurred. Brain CT scan revealed a right SDH. The patient underwent surgery and fully recovered three months after the drainage of the hematoma. We conducted a review of all cases in which SDH was associated to ECT. CONCLUSION: Early stage brain imaging is indispensable prior to starting ECT. Moreover, a previous medical history of SDH may not be a contraindication to ECT. In these situations, a clinical and radiological follow-up by both the psychiatrist and the neurosurgeon during all the ECT sessions is highly recommended.

Thoracic spine intra- and extradural dumbbell-shaped meningioma: Case report and extensive review of the literature with 21 cases.

INTRODUCTION: Spinal dumbbell-shaped meningioma is a rare condition usually mistaken preoperatively for schwannoma. The present study reported a case of dumbbell-shaped meningioma, with an extensive review of literature. METHODS: A documented case of thoracic spine dumbbell-shaped meningioma is reported, followed by an extensive review of the literature to analyze epidemiological features, pathogenesis, histopathological diagnosis, location, Eden classification, surgical treatment and outcome in such tumors. RESULTS: Case report: A 55 year-old woman was admitted with paraparesis and paresthesia of lower limbs. MRI showed a dumbbell-shaped meningioma of the thoracic spine. The tumor was totally removed via a posterolateral approach. REVIEW OF THE LITERATURE: Twenty-one spinal dumbbell-shaped meningiomas were reported in the last twenty years (1997-2017). Mean patient age was 46.57 years, with female predominance. Mean disease progression was 23.11 months. The thoracic spine was the predominant site (38.09%), followed by the cervical spine (33.33%). Eden type-3 was the most frequent tumor type, accounting for 66.67% of cases. In all cases, meningiomas were classified as WHO grade I. Complete removal (Simpson I-II) was achieved in 75% of cases. There was recurrence in 3 patients (14%), including 1 case of malignant transformation leading to death at 12 years post-surgery. CONCLUSION: Spinal dumbbell-shaped meningioma is mainly of the benign subtype. Long-term follow-up shows low rates of morbidity and mortality.