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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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Postoperative sagittal T2-weighted imaging obtained 5 years after surgery. No recurrence of the tumor is evident
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Fig4: Postoperative sagittal T2-weighted imaging obtained 5 years after surgery. No recurrence of the tumor is evident

Mentions: The postoperative course was uneventful and the patient gradually recovered all neurological functions. Motor and sensory functions of the lower extremities and bladder function showed complete normalization within 2 weeks. The patient wore a thoraco-lumbo-sacral orthosis for 3 months. CT confirmed primary bone union within 6 months (Fig. 3). Postoperative instability has not occurred as of the latest follow-up at 5 years after surgery. MRI 5 years postoperatively showed no recurrence of the tumor (Fig. 4).Fig. 3


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)

Postoperative sagittal T2-weighted imaging obtained 5 years after surgery. No recurrence of the tumor is evident
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Postoperative sagittal T2-weighted imaging obtained 5 years after surgery. No recurrence of the tumor is evident
Mentions: The postoperative course was uneventful and the patient gradually recovered all neurological functions. Motor and sensory functions of the lower extremities and bladder function showed complete normalization within 2 weeks. The patient wore a thoraco-lumbo-sacral orthosis for 3 months. CT confirmed primary bone union within 6 months (Fig. 3). Postoperative instability has not occurred as of the latest follow-up at 5 years after surgery. MRI 5 years postoperatively showed no recurrence of the tumor (Fig. 4).Fig. 3

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