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

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Spinal meningiomas (sMNGs) are relatively rare in comparison to intracranial MNGs. sMNGs localized anterior to the denticulate ligament (aMNGs) represent a surgically challenging subgroup. A high perioperative complication rate due to the need for complex surgical approaches has been described. In the present study, the authors report on their surgical experience that involves two institutions in which 207 patients underwent surgery for sMNGs. Special focus was placed on patients with aMNGs that were treated via a unilateral posterior approach (ULPA).


Between 2005 and 2017, 207 patients underwent resection of sMNGs at one of two institutions. The following characteristics were assessed: tumor size and localization, surgical approach, duration of surgery, grade of resection, peri- and postoperative complication rates, and neurological outcome. Data were compared between the subgroups of patients according to the lesion’s relationship to the denticulate ligament and to surgical approach.


The authors identified 48 patients with aMNGs, 86 patients with lateral MNGs, and 76 patients with posterior MNGs (pMNGs). Overall, 66.6% of aMNGs and 64% of pMNGs were reached via a ULPA. aMNGs that were approached via a ULPA showed reduced duration of surgery (131 vs 224 minutes, p < 0.0001) and had surgical complication rates and neurological outcomes comparable to those of lesions that were approached via a bilateral approach. No significant differences in complication rate, outcomes, and extent of resection were seen between aMNGs and pMNGs.


The duration of surgery, extent of resection, and outcomes are comparable between aMNGs and pMNGs when removed via a ULPA. Thus, ULPA represents a safe route to achieve a gross-total resection, even in cases of aMNG.

ABBREVIATIONS AMNG = anterior meningioma; BLPA = bilateral posterior approach; GTR = gross-total resection; KPS = Karnofsky Performance Scale; pMNG = posterior meningioma; sMNG = spinal meningioma; ULPA = unilateral posterior approach.

Article Information

Correspondence Peter Vajkoczy: Universitätsmedizin Charité Berlin, Germany.

INCLUDE WHEN CITING Published online December 7, 2018; DOI: 10.3171/2018.8.SPINE18198.

Disclosures Dr. Meyer reports being a consultant for Medtronic, DePuy, Icotec, Ulrich Medical, Brainlab, and Relievant. He has received support from Relievant, Icotec, and Medtronic for non–study-related clinical or research efforts. He receives royalties from Spineart.

© AANS, except where prohibited by US copyright law.



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    A: Mean age at diagnosis of an sMNG depending on the lesion’s localization within the spinal canal. B: Percentage of axial spinal canal occupied by the MNG. C: Size of sMNG in terms of longitudinal, sagittal, and axial diameter. D: Distribution of sMNGs within the spinal canal and according to the denticulate ligament. E: Surgical approaches, which were used for different MNG localizations. ns = not significant.

  • View in gallery

    A: Surgical duration in minutes (min.) according to approach and localization of the MNG. B: Extent of resection according to Simpson grade. C: Hospital stay in days according to the localization of the sMNG. D: Surgical complication rate according to localization of the MNG within the spinal canal. E: Changes in McCormick score before and after resection.

  • View in gallery

    Preoperative sagittal (A) and axial (B) MR images with contrast agent showing an aMNG at the thoracolumbar junction. Postoperative sagittal (C) and axial (D) MR images showing complete resection of the aMNG. Postoperative CT scans (E and F) demonstrating the extent of bony removal for a ULPA.



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