A Retrospective Cohort Study Evaluating the Comparative Effectiveness of Unilateral Hemilaminectomy and Bilateral Laminectomy in the Resection of Spinal Meningiomas

Abstract

BACKGROUND AND OBJECTIVES: The primary treatment modality for spinal meningiomas (SM) is surgical resection. In recent years, minimal invasive spine surgery has gained considerable popularity, attributing its growth to advancements in surgical technologies and improved training of surgeons. Nonetheless, the suitability and effectiveness of minimal invasive spine surgery for intradural spinal tumor resection remain a subject of debate. In this cohort study, we aimed to compare the extent of resection of the unilateral hemilaminectomy approach, a less invasive technique, with the more traditional and invasive bilateral laminectomy. METHODS: We performed a retrospective cohort study including patients with SM who underwent surgery at our department between 1996 and 2020. Cohorts included patients who underwent tumor resection through bilateral laminectomy and patients who underwent a unilateral hemilaminectomy. The primary end point was extent of resection according to the Simpson classification. RESULTS: Of 131 with SM, 36 had a bilateral laminectomy and 95 were operated through a unilateral hemilaminectomy. In both groups, gross total resection, Simpson grades 1 and 2, was achieved in 94.44% and 94.74%, respectively (P = .999). The neurological outcome was also comparable in both cohorts (P = .356). Both length of hospital stay and estimated blood loss were significantly lower in the unilateral cohort (P < .05). CONCLUSION: The results of this study indicate that the unilateral hemilaminectomy yields comparable results in both oncological and neurological outcome when compared with the bilateral laminectomy. Thus, unilateral hemilaminectomy may serve as a viable and safe alternative for the surgical removal of SM.

Timing of Resection of Spinal Meningiomas and Its Influence on Quality of Life and Treatment

“…GTR was achieved in 93.84% of all cases included in this study. Moreover, previous publications comparing both approaches show significantly less blood loss and lower LOS [11]. More invasive surgical approaches do not seem to be required in most cases, even in ventral located and calcified meningiomas [11,27,39,40], and other intradural tumors [41].…”

“…Moreover, previous publications comparing both approaches show significantly less blood loss and lower LOS [11]. More invasive surgical approaches do not seem to be required in most cases, even in ventral located and calcified meningiomas [11,27,39,40], and other intradural tumors [41]. Furthermore, minimal invasive unilateral approaches seem to play a role in preventing CSF leakage, one of the more frequent possible complications of after surgery on intra-dural pathologies [20,22,42,43].…”

“…Recently we demonstrated the resection of spinal meningiomas is feasible via a less invasive unilateral approach, showing a similar rate of gross total resection (GTR) in comparison to a bilateral laminectomy. Furthermore, we demonstrated that patients undergoing unilateral hemilaminectomy, with less muscle detachment and bone resection had significantly less blood loss (EBL) during the surgical procedure and faster recovery with significantly shorter length of hospital stay (LOS) [11]. Minimal invasive spine surgery (MISS) can further improve surgical outcomes though reduced surgical impact, decreased pain, quicker recovery [12][13][14].…”

Timing of Resection of Spinal Meningiomas and Its Influence on Quality of Life and Treatment

“…GTR was achieved in 93.84% of all cases included in this study. Moreover, previous publications comparing both approaches show significantly less blood loss and lower LOS [11]. More invasive surgical approaches do not seem to be required in most cases, even in ventral-located and calcified meningiomas [11,28,36,41] and other intradural tumors [42].…”

“…Recently, we demonstrated that the resection of spinal meningiomas is feasible via a less invasive unilateral approach, showing a similar rate of gross total resection (GTR) in comparison to a bilateral laminectomy. Furthermore, we demonstrated that patients undergoing unilateral hemilaminectomy, with less muscle detachment and bone resection, had significantly less blood loss (EBL) during the surgical procedure and faster recovery with significantly shorter length of hospital stay (LOS) [11]. Minimalinvasive spine surgery (MISS) can further improve surgical outcomes through reduced surgical impact, decreased pain, and quicker recovery [12][13][14].…”