Abstract

Background: Can elderly patients with thoracic meningioma and severe paraparesis benefit from delayed surgery?

Case Description: Two out of three octogenarians with severe preoperative paraparesis (all wheelchair-bound) were able to walk again following delayed (60–120 days from onset of deficit) surgical resection of thoracic spinal meningiomas.

Conclusion: Two out of three octogenarians with thoracic meningiomas causing severe paraparesis benefitted from the delayed (i.e. from 60 to 289 days) surgical resection of their tumors.

Keywords: Spinal meningioma, Spine surgery, Spine tumours, Tumour removal

INTRODUCTION

The limited literature suggests that even patients aged 70 years or older with severe paraparesies may benefit from the delayed surgical resection of spinal meningiomas.[ 3 , 4 ] Here, we present three octogenarians with thoracic meningioma and severe preoperative paraparesis of whom two neurologically improved despite the 60–120 day delay in resection of their tumors.

CLINICAL, DIAGNOSTIC, AND SURGICAL MANAGEMENT OF THREE OCTOGENARIANS WITH THORACIC MENINGIOMAS

Three octogenarians, aged 86–89 years, presented with severe paraparesis (not able to stand supported) attributed to thoracic meningiomas that were resected between 60 and 289 days following the onset of their severe paraparesis [ Table 1 ] and [ Figure 1 ]. The first patient underwent a T3 hemilaminectomy for a T3-T4 ventral thoracic meningioma; a gross total resection was achieved, and the patient walked without assistance 146 days postoperatively. The second patient with a T2-T3 lateral thoracic meningioma underwent surgical resection 120 days after the onset of a severe paraparesis; she was able to walk with assistance 135 days later. However, the third patient with a T6 dorsal thoracic meningioma operated on 289 days following the onset of a severe paraparesis failed to improve up to 91 days postoperatively.

Table 1:

The data for three octogenarians undergoing thoracic meningioma resection.

Figure 1:

The sagittal and axial view of meningiomas in gadolinium-enhanced magnetic resonance imaging.

DISCUSSION

In our small case series, delayed surgery (i.e. 60–289 days) for thoracic meningiomas in severely paraparetic patients resulted in the ability to walk in two out of three octogenarians.

Functional recovery following delayed resection of thoracic meningiomas

The literature regarding functional recovery for older patients with severe paraparesies undergoing delayed resection of thoracic meningiomas is limited. Cavanaugh et al. have reported a 101-year-old female with severe quadriparesis (with remained preoperative assisted walking ability) due to a cervical spinal meningioma. Postoperatively, she demonstrated partial recovery (insufficient information).[ 2 ] Sacko et al. reported outcomes of 70-year-old and older patients with paraplegia due to spinal meningiomas; 25 out of 26 paraplegic patients improved postoperatively.[ 4 ] Notably, neither patients’ age nor the interval between the onset of preoperative paraparesis and surgery were positively correlated with functional outcomes. Ashry et al. also reported the surgical outcomes of 20 patients who were paraplegic due to thoracic meningiomas of whom 14 patients recovered, and all of them had surgery within 14 days from the onset of paralysis.[ 1 ] When Schwake et al. studied 88 patients with spinal meningiomas, 73% of which were thoracic, motor deficits improved with surgery in 37 of 84 patients, while two deteriorated in the postoperative period.[ 5 ]

CONCLUSION

Two out of three octogenarians with long-standing, severe preoperative paraparesis/paraplegia due to thoracic meningioma significantly benefitted from 60-289 day delayed surgery.

Declaration of patient consent

Patient’s consent not required as patients identity is not disclosed or compromised.

Financial support and sponsorship

VVa received research funding from Helsinki University Hospital.

Conflicts of interest

There are no conflicts of interest.

References

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3. Engel DC, Gawellek L, Peraio S, Stanojevic M, Tatagiba M, Ebner FH. Spinal meningioma surgery in the elderly: Who benefits?. J Neurosurg Sci. 2018. 65: 408-13

4. Sacko O, Haegelen C, Mendes V, Brenner A, Sesay M, Brauge D. Spinal meningioma surgery in elderly patients with paraplegia or severe paraparesis: A multicenter study. Neurosurgery. 2009. 64: 503-9

5. Schwake M, Adeli A, Sporns P, Ewelt C, Schmitz T, Sicking J. Spinal meningiomas-risks and potential of an increasing age at the time of surgery. J Clin Neurosci. 2018. 57: 86-92