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KMID : 0388720210280020063
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Journal of Korean Society of Spine Surgery
2021 Volume.28 No. 2 p.63 ~ p.69
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Management of High-Grade Spinal Meningioma
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Kim Young-Hoon
Kim Sang-Il
Park Hyung-Youl
Kim Hun-Chul
Cho Chang-Hee
Kim Jong-Min
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Abstract
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Study Design: Review article.
Objectives: To review previous studies regarding high-grade spinal meningioma and to discuss its characteristics and proper management.
Summary of Literature Review: Although most cases of spinal meningioma are benign, some spinal meningiomas show atypical and aggressive clinical features. However, these high-grade spinal meningiomas are rare and their characteristics and proper management remain still unclear.
Materials and Methods: Review of the relevant articles.
Results: High-grade spinal meningioma shows a poorer prognosis than grade 1 spinal meningioma, with a higher recurrence rate and lower survival rate. The treatment of choice is complete resection of the tumor. If subtotal resection is performed or the histology of spinal meningioma is grade 3, adjuvant radiotherapy is considered. Systemic treatment can be considered when high-grade spinal meningioma shows metastasis and standard treatment is not feasible. However, there are drawbacks to many of these adjuvant therapies and few systemic therapies have been approved or shown to be efficacious. Recent studies have revealed genetic mutations associated with certain types of spinal meningioma, and immunotherapy is also under clinical trials.
Conclusions: High-grade spinal meningioma is a rare tumor with a poor prognosis. The initial surgical treatment is the most important factor for preventing recurrence. Adjuvant radiotherapy is considered in most cases of high-grade spinal meningioma. Due to the absence of sufficient evidence for the establishment of a treatment guideline, ongoing research and clinical trials are needed.
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KEYWORD
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Spine, Meningioma, Atypical, Anaplastic, Management
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