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En-bloc resection of thoracic calcified meningioma with inner dural layer in recapping T-saw laminoplasty: a case report.

Miyakoshi N, Hongo M, Kasukawa Y, Shimada Y - BMC Surg (2015)

Bottom Line: Postoperatively, the patient achieved complete recovery of neurological functions.Bone union after laminoplasty was obtained within 6 months.Recapping T-saw laminoplasty provides extensive exposure for tumor removal.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. miyakosh@doc.med.akita-u.ac.jp.

ABSTRACT

Background: In the treatment of spinal cord tumors, complete tumor resection with complete reconstruction of the spine represents the ideal goal. However, for the treatment of heavily calcified spinal meningioma, en-bloc resection of the tumor together with the involved dura at the tumor base through laminectomy is quite difficult. Conventional laminectomy is not wide enough to allow full exposure of such tumors, and postoperative dural defects can cause serious complications.

Case presentation: A 58-year-old Japanese woman presented with a 3-month history of progressive muscle weakness and numbness of the lower extremities. Magnetic resonance imaging (MRI) and computed tomography showed a calcified spinal cord tumor with dural tail sign at the T10-T11 level, severely compressing the spinal cord anterolaterally. The patient underwent en-bloc resection of the tumor with the inner layer of the dura and preservation of the outer layer of the dura through recapping T-saw laminoplasty of T10-T11, including bilateral facet joints. The tumor was histologically diagnosed as meningioma. Postoperatively, the patient achieved complete recovery of neurological functions. Bone union after laminoplasty was obtained within 6 months. Follow-up MRI at 5 years postoperatively demonstrated no recurrence of the tumor.

Conclusion: Resection of spinal meningioma with only the inner layer of dura can minimize postoperative complications, including spinal fluid leakage. Recapping T-saw laminoplasty provides extensive exposure for tumor removal. The combination of these techniques may offer an ideal surgical option for complete resection of spinal meningioma with complete preservation of the posterior spinal elements.

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Related in: MedlinePlus

Preoperative gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) and computed tomography (CT) of the thoracic spine. a MRI in the coronal orientation, b MRI in the sagittal orientation, and c MRI in the axial orientation showing an intradural extramedullary tumor with dural tail sign located on the left and dorsal sides at the T10-T11 level, compressing the spinal cord severely. d Sagittal reconstruction CT shows extensive peripheral calcification of the tumor
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Fig1: Preoperative gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) and computed tomography (CT) of the thoracic spine. a MRI in the coronal orientation, b MRI in the sagittal orientation, and c MRI in the axial orientation showing an intradural extramedullary tumor with dural tail sign located on the left and dorsal sides at the T10-T11 level, compressing the spinal cord severely. d Sagittal reconstruction CT shows extensive peripheral calcification of the tumor

Mentions: Magnetic resonance imaging (MRI) of the thoracic spine demonstrated an intradural extramedullary tumor located posterolaterally on the left side at the T10-T11 level, compressing the spinal cord severely to the ventral and right side. Contrast-enhanced MRI showed marked homogeneous enhancement with a dural tail sign (Fig. 1a-c). Computed tomography (CT) of the spine showed heavy peripheral calcification of the tumor (Fig. 1d). Based on these imaging findings, hard spinal meningioma with calcification located posterolateral to the spinal cord was diagnosed. For safe, complete, en-bloc resection of the tumor under good exposure, to minimize the risk of postoperative complications due to dural defect, and for complete preservation of the posterior spinal elements, we planned to resect this tumor with only the inner dural layer while preserving the outer dural layer through recapping T-saw laminoplasty.Fig. 1


En-bloc resection of thoracic calcified meningioma with inner dural layer in recapping T-saw laminoplasty: a case report.

Miyakoshi N, Hongo M, Kasukawa Y, Shimada Y - BMC Surg (2015)

Preoperative gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) and computed tomography (CT) of the thoracic spine. a MRI in the coronal orientation, b MRI in the sagittal orientation, and c MRI in the axial orientation showing an intradural extramedullary tumor with dural tail sign located on the left and dorsal sides at the T10-T11 level, compressing the spinal cord severely. d Sagittal reconstruction CT shows extensive peripheral calcification of the tumor
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4491201&req=5

Fig1: Preoperative gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) and computed tomography (CT) of the thoracic spine. a MRI in the coronal orientation, b MRI in the sagittal orientation, and c MRI in the axial orientation showing an intradural extramedullary tumor with dural tail sign located on the left and dorsal sides at the T10-T11 level, compressing the spinal cord severely. d Sagittal reconstruction CT shows extensive peripheral calcification of the tumor
Mentions: Magnetic resonance imaging (MRI) of the thoracic spine demonstrated an intradural extramedullary tumor located posterolaterally on the left side at the T10-T11 level, compressing the spinal cord severely to the ventral and right side. Contrast-enhanced MRI showed marked homogeneous enhancement with a dural tail sign (Fig. 1a-c). Computed tomography (CT) of the spine showed heavy peripheral calcification of the tumor (Fig. 1d). Based on these imaging findings, hard spinal meningioma with calcification located posterolateral to the spinal cord was diagnosed. For safe, complete, en-bloc resection of the tumor under good exposure, to minimize the risk of postoperative complications due to dural defect, and for complete preservation of the posterior spinal elements, we planned to resect this tumor with only the inner dural layer while preserving the outer dural layer through recapping T-saw laminoplasty.Fig. 1

Bottom Line: Postoperatively, the patient achieved complete recovery of neurological functions.Bone union after laminoplasty was obtained within 6 months.Recapping T-saw laminoplasty provides extensive exposure for tumor removal.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan. miyakosh@doc.med.akita-u.ac.jp.

ABSTRACT

Background: In the treatment of spinal cord tumors, complete tumor resection with complete reconstruction of the spine represents the ideal goal. However, for the treatment of heavily calcified spinal meningioma, en-bloc resection of the tumor together with the involved dura at the tumor base through laminectomy is quite difficult. Conventional laminectomy is not wide enough to allow full exposure of such tumors, and postoperative dural defects can cause serious complications.

Case presentation: A 58-year-old Japanese woman presented with a 3-month history of progressive muscle weakness and numbness of the lower extremities. Magnetic resonance imaging (MRI) and computed tomography showed a calcified spinal cord tumor with dural tail sign at the T10-T11 level, severely compressing the spinal cord anterolaterally. The patient underwent en-bloc resection of the tumor with the inner layer of the dura and preservation of the outer layer of the dura through recapping T-saw laminoplasty of T10-T11, including bilateral facet joints. The tumor was histologically diagnosed as meningioma. Postoperatively, the patient achieved complete recovery of neurological functions. Bone union after laminoplasty was obtained within 6 months. Follow-up MRI at 5 years postoperatively demonstrated no recurrence of the tumor.

Conclusion: Resection of spinal meningioma with only the inner layer of dura can minimize postoperative complications, including spinal fluid leakage. Recapping T-saw laminoplasty provides extensive exposure for tumor removal. The combination of these techniques may offer an ideal surgical option for complete resection of spinal meningioma with complete preservation of the posterior spinal elements.

Show MeSH
Related in: MedlinePlus