Posterior approach to ventrally located spinal meningiomas

Abstract

For the resection of anteriorly located meningiomas, various approaches have been used. Posterior approach is less invasive and demanding; however, it has been associated with increased risk of spinal cord injury. We evaluated ten consecutive patients that underwent surgery for spinal meningiomas. All patients were preoperative assessed by neurological examination, computed tomography and magnetic resonance imaging. All tumors were ventrally located and removed via a posterior approach. Transcranial motor-evoked potentials (TcMEPs), somatosensory-evoked potential (SSEP) and free running electromyography (EMG) were monitored intraoperative. Postoperative all patients had regular follow-up examinations. There were four males and six females. The mean age was 68.2 years (range 39-82 years). In nine out of ten cases, the tumor was located in the thoracic spine. A case of a lumbar meningioma was recorded. The most common presenting symptom was motor and sensory deficits and unsteady gait, whereas no patient presented with paraplegia. All meningiomas were operated using a microsurgical technique via a posterior approach. During the operation, free running EMG monitoring prompted a surgical alert in case of irritation, whereas TcMEP and SSEP amplitudes remained unchanged. Histopathology revealed the presence of typical (World Health Organisation grade I) meningiomas. The mean Ki-67/MIB-1 index was 2.75% (range 0.5-7). None of our patients sustained a transient or permanent motor deficit. After a mean follow-up period of 26 months (range 56-16 months), no tumor recurrence and no instability were found. Posterior approach for anteriorly located meningiomas is a safe procedure with the use of intraoperative monitoring, less invasive and well-tolerated especially in older patients. Complete tumor excision can be performed with satisfactory results.

Long-term recurrence rates after the removal of spinal meningiomas in relation to Simpson grades

“…In most cases, spinal cord meningiomas are WHO grade I tumors, and gross total removal is possible with a conventional posterior approach utilizing these anatomical features [1,2,4,5,[15][16][17][18]. Simpson grade I removal (macroscopically complete removal of a tumor and its visible extensions, with excision of its dural attachment and of any abnormal bone) [19] is considered the most effective way to avoid recurrence [5].…”

Giant solitary ancient schwannoma of the cervico-thoracic spine: a case report and review of the literature

“…However, they opined that if the lesion is in the cervical or upper-lumbar spine, early mobilisation might be hazardous if the spinal column has not been stabilised. Fear of destabilising the spine should not compromise the exposure required to safely remove these tumours 23,24 . The detection of calcification within a mass is important to estimate the difficulty of resection or post-operative prognosis as well as to narrow the differential diagnosis.…”

The lateral extracavitary approach to the thoracolumbar spine: a case series and systematic review

“…While some authors have reported using a direct posterior approach for treatment of ventral thoracic pathology, 31 most authors recommend avoiding it, as this technique risks damage to the spinal cord. 2,18,25,29,30 The costotransversectomy approach provides access to ipsilateral ventrolateral pathology extending to, but not across, the midline.…”