Rates of recurrence and symptom improvement following resection of spinal meningiomas in the pediatric population: individual participant data meta-analysis.
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INTRODUCTION: Spinal meningiomas are rare in the pediatric population. While resection is the standard of care, limited data is available on long-term trajectories and clinical outcomes after surgery. Additionally, pediatric spinal meningiomas are frequently associated with distinct histopathology and higher recurrence risk compared to adults. We conducted a meta-analysis to systematically evaluate clinical presentation, surgical outcomes, and recurrence patterns in pediatric spinal meningiomas, emphasizing the influence of extent of resection. METHODS: We performed a systematic review of Pubmed, Embase, Scopus, and Web of Science according to PRISMA guidelines for studies reporting outcomes of spinal meningioma resection in pediatric patients. English-language, human-subject studies reporting postoperative outcomes after resection of pediatric spinal meningiomas were included. Mixed-age surgical series were eligible when pediatric patient-level outcomes were directly extractable (recurrence and/or postoperative neurologic outcome with follow-up), while single-patient case reports were excluded. Recurrence and symptom improvement were synthesized using random-effects models to account for between-study heterogeneity. Recurrence and symptom improvement rates following gross total resection (GTR) and subtotal resection (STR) were compared with forest plots, Kaplan-Meier plots, and Cox proportional hazards models. RESULTS: Nine case series published between 1990 and 2022 with 46 patients were included. Extent of resection was reported for 42 patients (GTR, n = 33 [79%]; STR, n = 9 [21%]). The pooled recurrence rate was 34.9% (95% CI, 28.5-63.4%). Recurrence was less common in patients who underwent GTR than STR (GTR, 15.7% [95% CI, 5.9-33.5%]; STR, 77.8% [95% CI, 40.2-96.1%]). Symptom improvement occurred more frequently in patients who underwent GTR than STR (GTR, 92.0% [95% CI, 72.5-98.6%]; STR, 33.3% [95% CI, 6.0-75.9%]). Cox proportional hazards models revealed a higher hazard of recurrence with STR versus GTR (hazard ratio, 11.6; p < 0.001). CONCLUSION: In pediatric patients, spinal meningiomas are associated with high-grade histology and high rates of recurrence. While the extent of postoperative neurologic symptom improvement varies, most patients experience a partial alleviation of symptoms. Patients in which GTR was achieved had significantly lower recurrence rates and significantly higher symptom improvement rates compared to STR. This study highlights the importance of achieving GTR when possible, to maximize progression-free survival and quality of life.