Background: Due to the slow-growing nature of spinal meningiomas, they are mostly asymptomatic for a long time, and become symptomatic after the compression of the spinal cord or nerve roots. The aim of this study was to identify predictors for a poor clinical outcome after the surgical resection of spinal meningiomas and thereby to allow a preoperative identification of high-risk spinal meningiomas. Methods: Data acquisition was conducted as a single-center retrospective analysis. From 1 January 2004 to 31 December 2019, 121 patients who underwent surgical resection of a spinal meningioma were reviewed. Clinical and radiological data (such as tumor size, location, occupation ratio of the spinal canal, and the degree of spinal cord compression) were assessed. The functional clinical findings of the patients were recorded using the Karnofsky Performance Score, modified McCormick scale, and Frankel scale preoperatively, at discharge, and 3–6 months after surgery. Results: The mean patient age was 66 ± 13 years. A total of 104 (86%) patients were female and 17 (14%) were male. The thoracic spine (68%) was the most common location, followed by the cervical (29%) and lumbar (3%) spine. Preoperatively, 11.7% of patients were categorized as McCormick 1, 35.8% as 2, 39.2% as 3, 11.7% as 4, and 1.7% as 5. The neurological function of the patients with a functional deficit prior to surgery improved in 46% of the patients, remained unchanged in 52%, and worsened in 2% at discharge. At early follow-up, the proportions were 54%, 28%, and 5%, respectively. Preoperative Frankel scale was a significant predictor of a postoperative deterioration. Patients with Frankel score A to C preoperatively had a 9.2 times higher chance of clinical deterioration postoperatively (OR = 9.16). We found that the Frankel scale weakly correlated with the degree of spinal cord compression. In this study, other radiological parameters, such as the degree of cord compression and spinal canal occupation ratio, did not show a significant effect on the outcome. Conclusions: Surgery of intraspinal meningiomas can be considered safe. Neurological function improves in a large proportion of patients after surgery. However, a relevant preoperative deficit according to the Frankel scale (grade A–C) was a significant predictor of a postoperative neurological deterioration.
背景：由于脊髓脊膜瘤生长缓慢，多数患者长期无症状，直至脊髓或神经根受压后才出现症状。本研究旨在识别影响脊髓脊膜瘤手术切除后不良临床结局的预测因素，以实现术前高风险脊髓脊膜瘤的识别。方法：采用单中心回顾性分析方法收集数据。回顾分析了2004年1月1日至2019年12月31日期间接受脊髓脊膜瘤手术切除的121例患者。评估临床及影像学数据（如肿瘤大小、位置、椎管占位比及脊髓受压程度）。分别在术前、出院时及术后3-6个月采用卡氏功能状态评分、改良McCormick分级和Frankel分级记录患者功能状态。结果：患者平均年龄为66±13岁。女性104例（86%），男性17例（14%）。肿瘤最常见部位为胸椎（68%），其次为颈椎（29%）和腰椎（3%）。术前McCormick分级：1级11.7%，2级35.8%，3级39.2%，4级11.7%，5级1.7%。术前存在神经功能缺损的患者中，出院时46%改善，52%无变化，2%恶化；早期随访时比例分别为54%、28%和5%。术前Frankel分级是术后神经功能恶化的显著预测因素：术前Frankel分级A-C级的患者术后临床恶化风险增加9.2倍（OR=9.16）。研究发现Frankel分级与脊髓受压程度呈弱相关。本研究中其他影像学参数（如脊髓受压程度、椎管占位比）对预后无显著影响。结论：脊髓脊膜瘤手术安全性良好，多数患者术后神经功能改善。但术前Frankel分级A-C级的显著神经功能缺损是术后神经功能恶化的有效预测指标。
Predictors of Neurological Worsening after Resection of Spinal Meningiomas
肿瘤(癌症)患者之家