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Posterolateral approach for spinal intradural meningioma with ventral attachment.

Takami T, Naito K, Yamagata T, Yoshimura M, Arima H, Ohata K - J Craniovertebr Junction Spine (2015 Oct-Dec)

Bottom Line: 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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

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.

No MeSH data available.


Related in: MedlinePlus

Schematic drawings demonstrating the basic concept of the surgical technique
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Figure 4: Schematic drawings demonstrating the basic concept of the surgical technique

Mentions: Laminectomy was performed in the usual en bloc manner. The laminectomy was made long enough to expose the entire lesion and widened to the medial pedicular surface. Medial facetectomy was added to the tumor side. The dura mater was opened while preserving the arachnoid membrane. The arachnoid membrane was also opened with care to avoid damage at the points of arachnoid adherence or vascular connection [Figure 2a]. The dentate ligament was carefully resected from the inner surface of the dura mater and drawn back to the opposite side. The spinal cord was gently rotated and fixed to make a posterolateral surgical corridor [Figures 2b and 3a]. The surgical technique enables the surgeon to take a relatively narrow but direct surgical corridor to the ventral canal [Figure 4]. The tumor was removed in piecemeal fashion or resected sharply with minimal manipulation of the spinal cord with the help of internal decompression [Figure 3b and c]. Bipolar cautery was helpful for shrinking the tumor. The body of the patient can be angled to enhance the surgical corridor. After tumor removal, the dural attachment of the tumor was completely resected (Simpson grade 1) [Figure 3d] or coagulated meticulously (Simpson grade 2) to achieve complete resection of Simpson grade 1 or 2. In cases where the dural attachment of the tumor was completely resected in younger patients, autologous fascia lata was grafted to repair the defect in the dura mater [Figure 3e]. After complete resection of the tumor, rotation of the spinal cord was secured to the original position [Figure 3f]. Resected laminae were constructed in lift-up style for the cervical spine or onlay style for the thoracic spine using a titanium mini-plate and screws.[20] No rigid orthosis was applied after surgery. Supplemental digital content of surgical video Patient 7 was provided.


Posterolateral approach for spinal intradural meningioma with ventral attachment.

Takami T, Naito K, Yamagata T, Yoshimura M, Arima H, Ohata K - J Craniovertebr Junction Spine (2015 Oct-Dec)

Schematic drawings demonstrating the basic concept of the surgical technique
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660493&req=5

Figure 4: Schematic drawings demonstrating the basic concept of the surgical technique
Mentions: Laminectomy was performed in the usual en bloc manner. The laminectomy was made long enough to expose the entire lesion and widened to the medial pedicular surface. Medial facetectomy was added to the tumor side. The dura mater was opened while preserving the arachnoid membrane. The arachnoid membrane was also opened with care to avoid damage at the points of arachnoid adherence or vascular connection [Figure 2a]. The dentate ligament was carefully resected from the inner surface of the dura mater and drawn back to the opposite side. The spinal cord was gently rotated and fixed to make a posterolateral surgical corridor [Figures 2b and 3a]. The surgical technique enables the surgeon to take a relatively narrow but direct surgical corridor to the ventral canal [Figure 4]. The tumor was removed in piecemeal fashion or resected sharply with minimal manipulation of the spinal cord with the help of internal decompression [Figure 3b and c]. Bipolar cautery was helpful for shrinking the tumor. The body of the patient can be angled to enhance the surgical corridor. After tumor removal, the dural attachment of the tumor was completely resected (Simpson grade 1) [Figure 3d] or coagulated meticulously (Simpson grade 2) to achieve complete resection of Simpson grade 1 or 2. In cases where the dural attachment of the tumor was completely resected in younger patients, autologous fascia lata was grafted to repair the defect in the dura mater [Figure 3e]. After complete resection of the tumor, rotation of the spinal cord was secured to the original position [Figure 3f]. Resected laminae were constructed in lift-up style for the cervical spine or onlay style for the thoracic spine using a titanium mini-plate and screws.[20] No rigid orthosis was applied after surgery. Supplemental digital content of surgical video Patient 7 was provided.

Bottom Line: 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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

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.

No MeSH data available.


Related in: MedlinePlus