Spinal meningiomas: Treatment outcome and long-term follow-up.

BACKGROUND: Spinal intradural tumors can be classified as intradural extramedullary or intramedullary tumors. Spinal meningiomas are among the most frequent intradural, extramedullary tumors (IDEMs), representing 12 % of all meningiomas and 25-45 % of all intradural spinal tumors. OBJECTIVE: To evaluate postoperative outcome, defined by mortality, tumor recurrence and modified Rankin Scale in patients with spinal meningiomas. Furthermore, to identify factors related to these outcome measures and define possible prognosticators. METHODS: A large single center retrospective analysis of 166 consecutive spinal meningioma patients during a 29-year period (1989-2018). RESULTS: Female to male ratio was 5.15 to 1. Of all 166 resected tumors, 159 were WHO grade I and seven were WHO grade II. Histopathologically, the psammomatous type was most common (42.8 %). The thoracic region was the most frequent location (71.1 %), followed by cervical and lumbar locations. A complete resection (Simpson I-III) was achieved in 88.7 %. In 12 cases (7.2 %) recurrences of a spinal meningioma occurred after an interval of 0.70-13.78 years. Postoperative complications consisted of CSF leakage and wound healing problems. Three patients died of direct postoperative complications (1.8 %), nine patients died in follow-up due to unrelated causes. Post-operative complications were related to the overall outcome (p = 0.029). Clinical outcome showed improvement in 117 patients out of 148 (79.1 %) according to modified Rankin Scale; 24 patients remained stable and 7 patients deteriorated. Patients with pre-existing bladder/bowel problems and incomplete resections had higher chance of recurrences. Younger patients also had a higher recurrence rate. Follow-up ranged from 0 to 23 years, median of 0.77 years, most were discontinued after 2 years. CONCLUSIONS: The primary treatment of spinal meningiomas remains surgery. Complete resection of spinal meningiomas is achieved in most of the cases, however preserving and improving neurological status has priority over complete tumor resection. Morbidity and mortality is relatively low. Longer follow-up periods are recommended, since recurrences can occur after 10-15 years.

[Serious delayed intracranial complications after mild traumatic brain injury in oral anticoagulant use]. / Ernstige late intracraniële afwijkingen na licht schedel-hersenletsel bij oraal anticoagulantiagebruik.

BACKGROUND: Patients with mild traumatic brain injury (TBI) who use anticoagulants prior to injury have an increased risk of intracranial complications. Sometimes these complications are delayed, even if the initial CT scan of the head is normal. CASE DESCRIPTION: An 84-year-old woman who was using acenocoumarol presented elsewhere with mild TBI. She had no focal neurological deficit. The initial CT scan revealed no abnormalities and the patient was discharged home. That evening she had diffuse headache. The next day she was found with a reduced level of consciousness and was brought to our hospital. Her INR was 9.0 and a new CT scan showed an acute, left-sided subdural haematoma with a large mass effect. CONCLUSION: Serious delayed intracranial complications in patients with mild TBI who use anticoagulants are rare. In these patients INR measurement and a CT scan of the head are always indicated. Admission for observation may be considered. On discharge it is necessary to give clear instructions about warning symptoms.

The importance of microsurgery in childhood meningioma: a case report.

INTRODUCTION: Although meningiomas are frequently diagnosed in adults, it is a rare (intracranial) tumor in the pediatric population, with an incidence of 0.06/100,000. The pathology and treatment of meningiomas in adulthood has been a topic of increasing investigation. So far, the treatment of pediatric meningiomas has been extrapolated from these results. The question remains, however, whether translation of adult meningioma data into the childhood population is legitimate. METHODS: We present the case of a 3-year-old girl diagnosed with an intraventricular malignant meningioma and type 2 neurofibromatosis. She was operated on multiple times to achieve complete resection and received adjuvant chemotherapy. Since, she has been stable with no neurological sequelae and/or recurrence of the meningioma. CONCLUSION: Pediatric meningiomas are rare tumors and differ from their adult counterparts in various aspects. We believe that gross total resection of meningioma in the pediatric population, when possible, is the treatment of choice. In the event of a subtotal resection, repeat resection is recommended. Any adjuvant treatment with chemotherapy or radiation therapy should be carefully considered during multidisciplinary meetings.