{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:55:37Z","timestamp":1787752537740,"version":"build-2784847793"},"reference-count":61,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T00:00:00Z","timestamp":1655856000000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,6,13]]},"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Meningiomas are primary central nervous system tumours that arise from both cranial and spinal meninges. Spinal meningiomas occur less frequently than their cranial counterparts and are consequently given less attention in the literature. Therefore, systematic studies are needed to summarise the current knowledge on spinal meningiomas, providing a solid evidence base for treatment strategies. This systematic review of the literature will therefore assess studies describing spinal meningiomas, their epidemiology, diagnostics, treatment and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Electronic databases, including PubMed, Web of Science and Embase, will be searched using the keywords \u201cspinal\u201d and \u201cmeningioma\u201d. The search will be set to provide only English studies published after 2000 to avoid any conflicts regarding terminology and classification, as well as to reflect the current status. Case reports, editorials, letters and reviews will also be excluded. Reference lists of relevant records will also be searched. Identified studies will be screened for inclusion, by one reviewer in a first step and then three in the next step to decrease the risk of bias. The results will be categorised to allow for a structured summary of the outcomes and their evidence grade conforming to the Grading of Recommendations, Assessment, Development and Evaluation approach. Categories may include: epidemiology, histopathology, radiological diagnostics, surgery, complications, non-surgical or adjuvant treatments, disease outcomes and predictors, and lastly recurrence. This review will summarise the current knowledge on spinal meningiomas to allow for a better understanding of the disease and contribute to improve its management. For clinicians, the systematic collection and grading of available evidence may aid in decision making and for those seeking to further the scientific field, this review may help to identify areas where knowledge is currently lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval was not required for our systematic review as it is based on existing publications. The results will be disseminated via submission for publication in a peer-reviewed journal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-061614","type":"journal-article","created":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T11:12:26Z","timestamp":1655982746000},"page":"e061614","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Current knowledge on spinal meningiomas: a systematic review protocol"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9479-761X","authenticated-orcid":false,"given":"Victor Gabriel","family":"El-Hajj","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Pettersson Segerlind","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustav","family":"Burstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8781-1169","authenticated-orcid":false,"given":"Erik","family":"Edstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3776-6136","authenticated-orcid":false,"given":"Adrian","family":"Elmi-Terander","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,6,23]]},"reference":[{"key":"2025121300140850000_12.6.e061614.1","doi-asserted-by":"crossref","DOI":"10.3390\/biomedicines9030319","article-title":"Meningioma: a review of epidemiology, pathology, diagnosis, treatment, and future directions","volume":"9","author":"Ogasawara","year":"2021","journal-title":"Biomedicines"},{"key":"2025121300140850000_12.6.e061614.2","doi-asserted-by":"crossref","first-page":"E886","DOI":"10.1097\/BRS.0000000000000974","article-title":"Descriptive epidemiology of spinal meningiomas in the United States","volume":"40","author":"Kshettry","year":"2015","journal-title":"Spine"},{"key":"2025121300140850000_12.6.e061614.3","doi-asserted-by":"crossref","DOI":"10.3171\/2016.5.FOCUS16163","article-title":"Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome","volume":"41","author":"Maiti","year":"2016","journal-title":"Neurosurg Focus"},{"key":"2025121300140850000_12.6.e061614.4","doi-asserted-by":"crossref","DOI":"10.3390\/cancers13133244","article-title":"Long-Term follow-up and predictors of functional outcome after surgery for spinal meningiomas: a population-based cohort study","volume":"13","author":"Pettersson-Segerlind","year":"2021","journal-title":"Cancers"},{"key":"2025121300140850000_12.6.e061614.5","doi-asserted-by":"crossref","first-page":"368","DOI":"10.3171\/2014.12.SPINE14974","article-title":"Effects of sex on the incidence and prognosis of spinal meningiomas: a surveillance, epidemiology, and end results study","volume":"23","author":"Westwick","year":"2015","journal-title":"J Neurosurg Spine"},{"key":"2025121300140850000_12.6.e061614.6","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1007\/s11060-018-2993-3","article-title":"Clinical and prognostic features of spinal meningioma: a thorough analysis from a single neurosurgical center","volume":"140","author":"Hua","year":"2018","journal-title":"J Neurooncol"},{"key":"2025121300140850000_12.6.e061614.7","doi-asserted-by":"crossref","DOI":"10.1016\/j.clineuro.2020.106238","article-title":"Spinal meningiomas: treatment outcome and long-term follow-up","volume":"198","author":"Kwee","year":"2020","journal-title":"Clin Neurol Neurosurg"},{"key":"2025121300140850000_12.6.e061614.8","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27390"},{"key":"2025121300140850000_12.6.e061614.9","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.37.12.897"},{"key":"2025121300140850000_12.6.e061614.10","doi-asserted-by":"crossref","DOI":"10.3171\/2015.5.FOCUS15143","article-title":"The genetic basis of intradural spinal tumors and its impact on clinical treatment","volume":"39","author":"Karsy","year":"2015","journal-title":"Neurosurg Focus"},{"key":"2025121300140850000_12.6.e061614.11","doi-asserted-by":"crossref","first-page":"12","DOI":"10.2176\/nmc.43.12","article-title":"Detection of chromosomal imbalances in spinal meningiomas by comparative genomic hybridization","volume":"43","author":"Arslantas","year":"2003","journal-title":"Neurol Med Chir"},{"key":"2025121300140850000_12.6.e061614.12","doi-asserted-by":"crossref","DOI":"10.3390\/ijms221910222","article-title":"Genomic biomarkers of meningioma: a focused review","volume":"22","author":"Pawloski","year":"2021","journal-title":"Int J Mol Sci"},{"key":"2025121300140850000_12.6.e061614.13","first-page":"258","article-title":"Spinal meningiomas in patients younger than 50 years of age: a 21-year experience","volume":"98","author":"Cohen-Gadol","year":"2003","journal-title":"J Neurosurg"},{"key":"2025121300140850000_12.6.e061614.14","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2021.611218","article-title":"Progesterone receptor expression in meningiomas: pathological and prognostic implications","volume":"11","author":"Maiuri","year":"2021","journal-title":"Front Oncol"},{"key":"2025121300140850000_12.6.e061614.15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41394-020-00368-0","article-title":"Paraplegia due to spinal meningioma during the third trimester of pregnancy: case report and literature review","volume":"7","author":"Antol\u00ednez Ayala","year":"2021","journal-title":"Spinal Cord Ser Cases"},{"key":"2025121300140850000_12.6.e061614.16","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1515\/med-2017-0029","article-title":"Pathophysiology of meningioma growth in pregnancy","volume":"12","author":"Hortob\u00e1gyi","year":"2017","journal-title":"Open Med"},{"key":"2025121300140850000_12.6.e061614.17","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-81132-8"},{"key":"2025121300140850000_12.6.e061614.18","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-007-0345-7"},{"key":"2025121300140850000_12.6.e061614.19","doi-asserted-by":"publisher","DOI":"10.1007\/s13244-013-0302-4"},{"key":"2025121300140850000_12.6.e061614.20","doi-asserted-by":"crossref","first-page":"907","DOI":"10.2176\/nmc.oa.2013-0311","article-title":"Is Simpson grade I removal necessary in all cases of spinal meningioma? assessment of postoperative recurrence during long-term follow-up","volume":"54","author":"Tsuda","year":"2014","journal-title":"Neurol Med Chir"},{"key":"2025121300140850000_12.6.e061614.21","doi-asserted-by":"crossref","first-page":"4025","DOI":"10.1007\/s00586-015-4306-2","article-title":"Long-Term recurrence rates after the removal of spinal meningiomas in relation to Simpson grades","volume":"25","author":"Kim","year":"2016","journal-title":"Eur Spine J"},{"key":"2025121300140850000_12.6.e061614.22","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1007\/s00701-020-04280-2","article-title":"Spinal meningiomas: is Simpson grade II resection radical enough?","volume":"162","author":"Vold\u0159ich","year":"2020","journal-title":"Acta Neurochir"},{"key":"2025121300140850000_12.6.e061614.23","doi-asserted-by":"crossref","DOI":"10.1097\/BRS.0b013e31824167f1","article-title":"Long-Term surgical outcomes of spinal meningiomas","volume":"37","author":"Nakamura","year":"2012","journal-title":"Spine"},{"key":"2025121300140850000_12.6.e061614.24","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-83712-0","article-title":"Surgical results of the resection of spinal meningioma with the inner layer of dura more than 10 years after surgery","volume":"11","author":"Tominaga","year":"2021","journal-title":"Sci Rep"},{"key":"2025121300140850000_12.6.e061614.25","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1097\/00007632-200108150-00017","article-title":"A novel technique for surgical resection of spinal meningioma","volume":"26","author":"Saito","year":"2001","journal-title":"Spine"},{"key":"2025121300140850000_12.6.e061614.26","doi-asserted-by":"crossref","first-page":"2905","DOI":"10.1007\/s00701-020-04416-4","article-title":"Incidence and predictors of kyphotic deformity following resection of cervical intradural tumors in adults: a population-based cohort study","volume":"162","author":"Tatter","year":"2020","journal-title":"Acta Neurochir"},{"key":"2025121300140850000_12.6.e061614.27","doi-asserted-by":"crossref","first-page":"300","DOI":"10.3340\/jkns.2007.42.4.300","article-title":"Surgical outcome of spinal canal meningiomas","volume":"42","author":"Yoon","year":"2007","journal-title":"J Korean Neurosurg Soc"},{"key":"2025121300140850000_12.6.e061614.28","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.wneu.2014.12.015","article-title":"Complication avoidance in the resection of spinal meningiomas","volume":"83","author":"Westwick","year":"2015","journal-title":"World Neurosurg"},{"key":"2025121300140850000_12.6.e061614.29","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1016\/j.wneu.2015.01.049","article-title":"Spinal meningioma resection","volume":"83","author":"Bydon","year":"2015","journal-title":"World Neurosurg"},{"key":"2025121300140850000_12.6.e061614.30","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s10143-018-0961-1","article-title":"Spinal meningiomas prognostic evaluation score (SPES): predicting the neurological outcomes in spinal meningioma surgery","volume":"42","author":"Frati","year":"2019","journal-title":"Neurosurg Rev"},{"key":"2025121300140850000_12.6.e061614.31","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1093\/neuros\/nyaa561","article-title":"Improvement in quality of life following surgical resection of benign intradural extramedullary tumors: a prospective evaluation of patient-reported outcomes","volume":"88","author":"Newman","year":"2021","journal-title":"Neurosurgery"},{"key":"2025121300140850000_12.6.e061614.32","doi-asserted-by":"crossref","first-page":"640","DOI":"10.3171\/2016.4.SPINE151149","article-title":"Improved patient quality of life following intradural extramedullary spinal tumor resection","volume":"25","author":"Viereck","year":"2016","journal-title":"J Neurosurg Spine"},{"key":"2025121300140850000_12.6.e061614.33","doi-asserted-by":"crossref","DOI":"10.3390\/cancers13246371","article-title":"Health-Related quality of life and return to work after surgery for spinal meningioma: a population-based cohort study","volume":"13","author":"Pettersson-Segerlind","year":"2021","journal-title":"Cancers"},{"key":"2025121300140850000_12.6.e061614.34","doi-asserted-by":"crossref","DOI":"10.3171\/2019.3.FOCUS1969","article-title":"Trends in the utilization of radiotherapy for spinal meningiomas: insights from the 2004-2015 National cancer database","volume":"46","author":"Yolcu","year":"2019","journal-title":"Neurosurg Focus"},{"key":"2025121300140850000_12.6.e061614.35","doi-asserted-by":"publisher","DOI":"10.1177\/1049732312452938"},{"key":"2025121300140850000_12.6.e061614.36","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-4-1"},{"key":"2025121300140850000_12.6.e061614.37","unstructured":"Zotero . Roy Rosenzweig center for history and new media, 2016. Available: www.zotero.org\/download"},{"key":"2025121300140850000_12.6.e061614.38","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4"},{"key":"2025121300140850000_12.6.e061614.39","unstructured":"OCEBM Levels of Evidence Working Group . The Oxford 2011 levels of evidence. Oxford centre for evidence-based medicine. Available: http:\/\/www.cebm.net\/index.aspx?o=5653"},{"key":"2025121300140850000_12.6.e061614.40","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.85B1.14063"},{"key":"2025121300140850000_12.6.e061614.41","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.1227\/NEU.0000000000000946","article-title":"Optimal timing of surgical decompression for acute traumatic central cord syndrome: a systematic review of the literature","volume":"77 Suppl 4","author":"Anderson","year":"2015","journal-title":"Neurosurgery"},{"key":"2025121300140850000_12.6.e061614.42","doi-asserted-by":"publisher","DOI":"10.1186\/s40779-020-00238-8"},{"key":"2025121300140850000_12.6.e061614.43","unstructured":"Sch\u00fcnemann H , Bro\u017cek J , Guyatt G . Grade Handbook for grading quality of evidence and strength of recommendations. The GRADE Working Group, 2013. guidelinedevelopment.org\/handbook"},{"key":"2025121300140850000_12.6.e061614.44","unstructured":"GRADEpro . GRADEpro GDT: GRADEpro Guideline Development Tool [Software] McMaster University, Evidence Prime, Inc; 2020. gradepro.org"},{"key":"2025121300140850000_12.6.e061614.45","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13643-015-0070-y","article-title":"Managing the incidence of selective reporting bias: a survey of cochrane review groups","volume":"4","author":"Reid","year":"2015","journal-title":"Systematic Reviews"},{"key":"2025121300140850000_12.6.e061614.46","doi-asserted-by":"crossref","first-page":"E967","DOI":"10.1097\/BRS.0000000000000412","article-title":"Incidence rates and surgery of primary intraspinal tumors in the era of modern neuroimaging: a national population-based study","volume":"39","author":"Weber","year":"2014","journal-title":"Spine"},{"key":"2025121300140850000_12.6.e061614.47","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-008-0685-y"},{"key":"2025121300140850000_12.6.e061614.48","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jocn.2020.05.042","article-title":"Functional outcome after surgical treatment of spinal meningioma","volume":"77","author":"Hohenberger","year":"2020","journal-title":"J Clin Neurosci"},{"key":"2025121300140850000_12.6.e061614.49","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1097\/01.brs.0000141173.79572.40","article-title":"Results in the operative treatment of elderly patients with spinal meningiomas","volume":"29","author":"Morandi","year":"2004","journal-title":"Spine"},{"key":"2025121300140850000_12.6.e061614.50","doi-asserted-by":"crossref","DOI":"10.4103\/2152-7806.139642","article-title":"Surgical management of spinal meningiomas: a retrospective case analysis based on preoperative surgical grade","volume":"5","author":"Arima","year":"2014","journal-title":"Surg Neurol Int"},{"key":"2025121300140850000_12.6.e061614.51","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1227\/01.NEU.0000338427.44471.1D","article-title":"Spinal meningioma surgery in elderly patients with paraplegia or severe paraparesis: a multicenter study","volume":"64","author":"Sacko","year":"2009","journal-title":"Neurosurgery"},{"key":"2025121300140850000_12.6.e061614.52","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-004-0809-y"},{"key":"2025121300140850000_12.6.e061614.53","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s11060-005-1469-4","article-title":"Spinal meningioma: relationship between histological subtypes and surgical outcome?","volume":"75","author":"Schaller","year":"2005","journal-title":"J Neurooncol"},{"key":"2025121300140850000_12.6.e061614.54","doi-asserted-by":"crossref","DOI":"10.3171\/FOC-07\/10\/E14","article-title":"Management of spinal meningiomas: surgical results and a review of the literature","volume":"23","author":"Setzer","year":"2007","journal-title":"Neurosurg Focus"},{"key":"2025121300140850000_12.6.e061614.55","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s11060-018-2929-y","article-title":"Spinal meningioma and factors predictive of post-operative deterioration","volume":"140","author":"Gilard","year":"2018","journal-title":"J Neurooncol"},{"key":"2025121300140850000_12.6.e061614.56","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200003150-00013"},{"key":"2025121300140850000_12.6.e061614.57","doi-asserted-by":"crossref","first-page":"446","DOI":"10.23736\/S0390-5616.17.04102-9","article-title":"Spinal meningiomas: 61 cases with predictors of early postoperative surgical outcomes","volume":"64","author":"Bayoumi","year":"2020","journal-title":"J Neurosurg Sci"},{"key":"2025121300140850000_12.6.e061614.58","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyw092"},{"key":"2025121300140850000_12.6.e061614.59","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-3019(99)00153-6"},{"key":"2025121300140850000_12.6.e061614.60","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2013.09.001"},{"key":"2025121300140850000_12.6.e061614.61","doi-asserted-by":"crossref","unstructured":"Lasserson TJ , Thomas J , Higgins JPT . Chapter 1: Starting a review. In: Higgins JPT , Thomas J , Chandler J , et al , eds. Cochrane Handbook for systematic reviews of interventions version 6.2. Cochrane, 2021. www.training.cochrane.org\/handbook","DOI":"10.1002\/9781119536604.ch1"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-061614","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T08:14:23Z","timestamp":1765613663000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-061614"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6]]},"references-count":61,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6,23]]},"published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1136\/bmjopen-2022-061614"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-061614","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6]]}}}