Surgical management of ventrally located spinal meningiomas via posterior approach

Background

Spinal meningioma is a relatively common tumor among intradural extramedullary spinal tumors. When the locus of the meningioma is located on the ventral side, tumor removal, dura mater resection, and reconstruction via a posterior approach safety become technically difficult.

Methods

Twelve patients, who received surgical treatment for ventral spinal meningioma via a posterior approach, were included. There were three male and nine female patients, with an average age of 66.3 years (47–88 years). The average observation period was 55.4 months (22–132 months). In these cases, we analyzed the spinal level of tumor position, histopathological type (subtype), the grade of tumor resection (Simpson grade), pre- and post-operative walking state (Nurick grade), perioperative neurological complications, and the recurrence.

Results

Spinal meningioma occurred in the cervical spinal cord in three cases, with a further nine cases in the thoracic spinal cord. Histopathologically, all 12 tumors were assessed as grade I on the WHO classification system (eight cases of meningothelial type and four cases of psammomatous type). The level of tumor resection was Simpson grade I resection for two cases and Simpson grade II resection for the remaining ten cases. The average of Nurick grade improved from 3.3 preoperatively to 1.3 postoperatively. In all cases, we identified no neurological complications. One incident of tumor recurrence was identified 11 years after an operation involving a Simpson grade II resection

Conclusion

Posterior approaches provide adequate exposure to safely remove ventrally located meningioma. Posterior exposures with lateral bone resection, dentate ligament division, provide also adequate exposure for safe removal.