Outcomes and prognosis of surgically treated thoracic spinal meningiomas: a multicenter cohort study.

Objective: Thoracic spinal meningiomas (TSMs) are common intradural extramedullary tumors and are usually surgically treated. Although surgery generally results in positive outcomes, some patients experience residual or new neurological impairments. The authors conducted a multicenter cohort study to investigate prognostic factors that affect functional recovery following TSM resection.

Methods: A multicenter retrospective cohort study from 3 tertiary centers was conducted and included all patients who underwent TSM resection between 2015 and 2023. Patients had a minimum 6-month follow-up with preoperative MRI and clinical evaluation. Functional outcomes were measured using the American Spinal Injury Association (ASIA) motor component score of the ASIA Impairment Scale and modified Japanese Orthopaedic Association thoracic myelopathy (mJOA-TM) score. The secondary outcome was postoperative complications.

Results: A total of 74 patients were included, with the majority presenting with lower limb radiculopathy and midthoracic tumors. Postoperative outcomes showed improvement in the median ASIA motor and mJOA-TM scores at 6 months. Univariate analysis identified significant predictors of ASIA motor score improvement to include age at diagnosis (p = 0.038), anteroposterior tumor dimension (p = 0.005), transverse dimension (p = 0.007), need for inpatient rehabilitation (p = 0.002), and worsened incontinence (p = 0.003). Significant predictors of mJOA-TM improvement were tumor volume (p < 0.001), craniocaudal dimension (p = 0.040), rehabilitation requirements (p = 0.045), presence of complications (p < 0.001), worsened motor deficits (p < 0.001), sensory deficits (p < 0.001), and incontinence (p < 0.001). Multivariate analysis confirmed that tumor dimensions (anteroposterior, p = 0.043; transverse, p = 0.039) and postoperative incontinence (p < 0.001) were independently associated with recovery in the ASIA motor score at 6 months; and age at diagnosis (p = 0.024), meningioma volume (p = 0.004), and worsened postoperative numbness (p < 0.001) were associated with recovery in the mJOA-TM score.

Conclusions: This multicenter study is the largest series of surgically treated TSMs reported to date. Resection of TSMs is associated with significant functional recovery despite the potential for postoperative complications. Tumor dimensions, tumor volume, and worsened postoperative neurological deficits are key determinants of functional recovery in surgically treated TSMs.