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.
Correspondence Peter Vajkoczy: Universitätsmedizin Charité Berlin, Germany. email@example.com.
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.
Aboul-EneinHAKhidrWMAbdeenKMMadawiAA: Surgical management of ventrally based lower cervical (subaxial) meningiomas through the lateral approach: report on 16 cases. Clin Neurol Neurosurg139:152–1582015
LouisDNPerryAReifenbergerGvon DeimlingAFigarella-BrangerDCaveneeWK: The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol131:803–8202016
PompiliACaroliFCrispoFGiovannettiMRausLVidiriA: Unilateral laminectomy approach for the removal of spinal meningiomas and schwannomas: impact on pain, spinal stability, and neurologic results. World Neurosurg85:282–2912016
SunSQCaiCRavindraVMGamblePYarbroughCKDaceyRG: Simpson grade I–III resection of spinal atypical (World Health Organization grade II) meningiomas is associated with symptom resolution and low recurrence. Neurosurgery76:739–7462015
TolaSDe AngelisMBistazzoniSChiaramonteCEspositoVPaoliniS: Hemilaminectomy for spinal meningioma: a case series of 20 patients with a focus on ventral- and ventrolateral lesions. Clin Neurol Neurosurg148:35–412016
TsudaKAkutsuHYamamotoTNakaiKIshikawaEMatsumuraA: Is Simpson grade I removal necessary in all cases of spinal meningioma? Assessment of postoperative recurrence during long-term follow-up. Neurol Med Chir (Tokyo)54:907–9132014