# Predictive factors in spinal meningiomas – a comparative analysis with intracranial meningiomas of a high-volume skull and base center

## TL;DR

Spinal meningiomas have better outcomes than intracranial ones, with complete surgery being key to reducing recurrence.

## Contribution

Identifies specific prognostic factors for spinal meningiomas and highlights the importance of high-volume centers for treatment.

## Key findings

- Spinal meningiomas had a significantly lower recurrence rate compared to intracranial meningiomas.
- Simpson resection grade and higher WHO grade were independent prognostic factors for spinal meningioma progression.
- Complete resection is the most significant modifiable factor for favorable outcomes in spinal meningiomas.

## Abstract

Microsurgical resection remains the gold standard in the treatment of spinal meningiomas. Available data suggest more favorable clinical outcomes compared to intracranial meningiomas. This study aims to enhance risk stratification and optimize treatment strategies by analyzing clinical and histopathological predictive factors for spinal meningiomas in a large single-center cohort. We present the analysis of 217 spinal meningiomas of our institutional meningioma cohort treated between October 2003 and March 2017. Clinical parameters of the patients such as sex, age, location of the meningioma and extent of resection were recorded besides histological features. Other parameters included follow-up and recurrence. The outcome parameters for spinal meningiomas were evaluated and compared with 1767 intracranial meningiomas. Among 217 spinal meningiomas, 80.37% (n = 172) were completely resected. The majority (96.31%, n = 209) were classified as CNS WHO grade 1. In contrast, the proportion of WHO grade 1 among intracranial meningiomas was 78.21% (n = 1382, p < 0.0001). Patients with spinal meningiomas had a lower recurrence rate with 6.91% (n = 15), versus 23.94% (n = 423) of patients with intracranial meningiomas (p < 0.0001). Multivariate analysis identified Simpson resection grade (p < 0.0001) and higher WHO grade (p = 0.0156) as independent prognostic factors for risk factors for progression in spinal meningiomas. For intracranial meningiomas, male gender (p = 0.0106) and resection of a recurrent tumor (p < 0.0001) were additionally identified as independent negative prognostic parameters. Spinal meningiomas are associated with a more favorable prognosis compared to their intracranial counterparts. The most significant and modifiable prognostic factor is the achievement of gross total resection. Given the technical complexity of surgery, spinal meningiomas should preferably be treated in high-volume centers with experienced surgeons to achieve this goal while minimizing morbidity and ensuring durable tumor control.

The online version contains supplementary material available at 10.1007/s10143-026-04151-x.