• Sam Q Sun, Chunyu Cai, Vijay M Ravindra, Paul Gamble, Chester K Yarbrough, Ralph G Dacey, Joshua L Dowling, Gregory J Zipfel, Neill M Wright, Paul Santiago, Clifford G Robinson, Meic H Schmidt, Albert H Kim, and Wilson Z Ray.
• *Washington University School of Medicine, Saint Louis, Missouri; ‡Department of Pathology and Immunology, Washington University, St. Louis, Missouri; §Department of Neurosurgery, University of Utah, Salt Lake City, Utah; ¶Department of Neurosurgery, Washington University, St. Louis, Missouri; ‖Department of Radiation Oncology, Washington University, St. Louis, Missouri.
• Neurosurgery. 2015 Jun 1;76(6):739-46.

BackgroundBecause of their rarity, outcomes regarding spinal atypical meningiomas (AMs) remain unclear.ObjectiveTo describe the recurrence rate and postoperative outcomes after resection of spinal AMs, and to discuss an appropriate resection strategy and adjuvant therapy for spinal AMs.MethodsData from all patients who presented with spinal AMs to 2 tertiary referral centers between 1998 and 2013 were obtained by chart review.ResultsFrom 102 patients with spinal meningioma, 20 AM tumors (7 cervical, 11 thoracic, 2 thoracolumbar) were identified in 18 patients (median age, 50 years [range, 19-75] at time of resection; 11% male; median follow-up, 32 months [range, 1-179] after resection). Before resection, patients had sensory deficits (70%), pain (70%), weakness (60%), ataxia (50%), spasticity (65%), and incontinence (35%). One tumor presented asymptomatically. Simpson grade I, II, III, and IV resection were achieved in 3 (15%), 13 (65%), 2 (10%), and 2 (10%) tumors, respectively. One patient that underwent Simpson grade III resection received adjuvant radiation therapy. After Simpson grade I-III or gross total resection, no tumors recurred (0%; confidence interval, 0%-17.6%). After Simpson grade IV resection, 1 tumor recurred (50%; confidence interval, 1.3%-98.7%). With the exception of 1 patient who had bilateral paraplegia perioperatively, all other patients experienced improvement of preoperative symptoms after surgery (median time, 3.6 months [range, 1-13] after resection).ConclusionDespite published cases suggesting an aggressive clinical course for spinal AMs, this series of spinal AMs reports that gross total resection without adjuvant radiation therapy resulted in symptom resolution and low recurrence.

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