Posterolateral approach for spinal intradural meningioma with ventral attachment

Abstract

Background:Spinal meningioma with ventral attachment is a challenging pathology. Several technical modifications have been proposed to secure safe and precise resection of these tumors.Materials and Methods:This retrospective study focused on the precise and safe surgery of spinal meningiomas with strictly ventral attachment of cervical or thoracic spine. The surgical technique included a lateral oblique position for the patient, laminectomy with unilateral medial facetectomy on the tumor side, and spinal cord rotation with the dentate ligament. The neurological status of patients was assessed using the modified McCormick functional schema (mMFS) and sensory pain scale (SPS) before and at least 3 months after surgery. Patients were followed-up for a mean of 23.7 months. Tumor removal was graded using the Simpson grade for removal of meningiomas, and the extent of excision was confirmed using early postoperative magnetic resonance imaging.Results:Simpson grade 1 or 2 resections were achieved in all cases. No major surgery-related complications were encountered, postoperatively. The mean mMFS score before surgery was 3.1, improving significantly to 1.7 after surgery (P < 0.05). The mean SPS score before surgery was 2.4, improving significantly to 1.6 after surgery (P < 0.05).Conclusions:This surgical technique offers a posterolateral surgical corridor to the ventral canal of both cervical and thoracic spine. The present preliminary analysis suggests that functional outcomes were satisfactory with minimal surgery-related complications, although considerable surgical experience is needed to achieve a high level of surgical confidence.

Surgical management of spinal meningiomas: focus on unilateral posterior approach and anterior localization

“…In the literature, more advanced approaches, such as the posterolateral or combined approaches with dorsal instrumentation, have been described to access aMNG. 9,17 In comparison to our results, the complication rates and access-related morbidity rates of these extended surgical approaches are high. 1 To our knowledge, we report on the largest cohort of sMNGs that have been approached via a ULPA.…”

“…sMNGs anterior to the denticulate ligament (aMNGs) represent a surgically challenging subgroup due to difficult surgical exposure, and thus increased peri-and postoperative complication rates have been discussed for this subgroup of lesions. 13,17,18 As a consequence, recent articles involving aMNGs have discussed anterior approaches that involve a single-level or multilevel vertebrectomy and placement of instrumentation; anterior approaches are more complex in nature than traditional posterior approaches. 9,12,13 These studies reported a complication rate for aMNG of up to 27%, mostly approach related.…”

Excision of a centrally based ventral intradural extramedullary tumor of the cervical spine through a direct posterior approach

“…Given the slow growth rate and nonmalignant characteristics, spinal meningiomas respond well to complete surgical excision, as in this case [15][16][17][18][19][20][21]. Precautions to avoid recurrence are important since revision surgery has proven substantially more challenging once the native arachnoid plane is disrupted by primary surgery [4,22]. Cohen-Gadol et al's findings suggest that patients over age 50 have a 5% recurrence rate following tumor removal [22,23].…”

“…Precautions to avoid recurrence are important since revision surgery has proven substantially more challenging once the native arachnoid plane is disrupted by primary surgery [4,22]. Cohen-Gadol et al's findings suggest that patients over age 50 have a 5% recurrence rate following tumor removal [22,23]. Ensuring sufficient tumor removal is dependent upon surgical approach and adequate exposure.…”

Posterior approach to ventrally and dorsally located spinal meningiomas

“…Клиническая симптоматика у пациентов с вентральными менингиомами на момент поступления была представлена локальной болью в спине (46,1 %), нарушением двигательных функций ( Для удаления вентральных менингиом разработаны и используются большие и травматичные доступы -заднелатеральный или передний с одно-или многоуровневой корпэктомией и инструментализацией [16,17], при этом частота послеоперационных осложнений, преимущественно связанных с доступом, достигает 27 % [16]. По сравнению с результатами авторов [2], использующих только задние доступы, частота рецидивов и неблагоприятных исходов при передних доступах выше [18].…”