Spinal Meningioma

Spinal meningiomas are benign extramedullary tumors arising from the arachnoid cap cells that predominantly affect females in the fifth to seventh decade of life. They most frequently occur in the thoracic spine. Magnetic resonance imaging is the imaging modality of choice for diagnosis, demonstrating avid homogenous enhancement of an extramedullary mass with or without both intra- and extradural components. Open surgical resection remains the mainstay of treatment for spinal meningiomas. Conventional fractionated radiotherapy and more recently hypofractionated radiosurgery have been employed in certain cases. Radiotherapy may be considered for the management of patients with residual or recurrent tumors after resection, in those patient whose tumors are not amenable to open surgical resection due to anatomical location, or for patients who are not surgical candidates. Doses of 45–54 Gy using fractions of 1.8 Gy are recommended. More recently, conformal radiosurgery may be preferred over conventional radiotherapy for the treatment of these benign tumors. MRI is the imaging modality of choice for radiosurgical planning. Doses of 12–16 Gy have been described for hypofractionated radiosurgery in a single session, 18 Gy for 3 fractions and 25–30 Gy for 5 fractions regimens. The complication of radiation-induced spinal cord injury has a rather low incidence. This complication can be avoided by optimizing total prescribed dose, fraction size, and careful delineation of both the target and neural structures. Similar to well-documented experience for intracranial meningiomas, the radiosurgical management for spinal meningiomas is a highly safe and effective treatment modality associated with long-term radiographic control.