Original ArticleMicrosurgical Management of Ventral Intradural-Extramedullary Cervical Meningiomas: Technical Considerations and Outcomes
Introduction
Spinal meningiomas are typically benign, slow-growing, intradural-extramedullary tumors that constitute 25%–46% of spinal cord neoplasms and approximately 1.2% of all meningiomas.1, 2, 3, 4 The thoracic spine is the most frequent location for spinal meningiomas, accounting for 75% of all cases.5,6 Cervical meningiomas are less common than tumors of other spine segments (approximately 15% of cases) and occur with a higher prevalence among patients <50 years old.7 The most effective treatment for spinal meningiomas is total surgical excision.
The surgical management of cervical meningiomas is dictated by tumor location. Compared with meningiomas of other spinal segments, cervical meningiomas have a greater tendency to be located anterior to the cord.3,5,7 Purely ventral cervical meningiomas present a unique surgical challenge for which limited data exist.7 In most cases, exposure of the ventral intradural space can be achieved through traditional posterior or posterolateral approaches. However, safe resection of purely ventral tumors with other complicating features (e.g., en plaque tumors, heavy calcifications, significant bilateral extension) may not be feasible through posterior avenues.8 Increasingly, reports have described the successful use of anterior cervical exposures to address ventral intradural-extramedullary lesions, including meningiomas,8, 9, 10, 11, 12 but the literature examining this approach is quite sparse.
The purpose of this retrospective study is to document our case series of 8 patients with purely ventral, intradural-extramedullary cervical meningiomas treated via 1 of 2 microneurosurgical approaches: the anterior approach with cervical corpectomy and instrumented fusion (2/8, 25%) or the posterolateral approach (6/8, 75%).The clinical characteristics, operative techniques, outcomes, and relevant literature are presented. In addition, a comprehensive review of similar reports to date in the English literature is provided.
Section snippets
Preoperative Assessment
Eight patients (3 men, 5 women; age range, 26–77 years) with a solitary, purely ventral, cervical meningioma who underwent surgery at the Department of Neurosurgery, Ankara University, between 2011 and 2019 were retrospectively studied. All consecutive tumors arising from C2-C7 were included in the study. Magnetic resonance imaging (MRI) of the cervical spine was performed in each case to anatomically characterize the lesion and surrounding tissues. T1-and T2-weighted images were evaluated for
Results
Clinical details of the study population are presented in Table 1. All patients had a purely ventral cervical meningioma involving the following levels: C2 (3/8, 37.5%), C3 (2/8, 25%), C6 (1/8, 12.5%), C7 (1/8, 12.5%). One patient harbored a multilevel tumor spanning C2-C5. The majority of patients (6/8, 75%) exhibited cord signal change on preoperative MRI. Nurick scores before surgery ranged from 1 to 4, with only 1 patient requiring assistance with gait. All patients presented with various
Discussion
Cervical meningiomas are rare lesions that occur disproportionately in patients <50 years old.7 The surgical approach to cervical meningiomas depends on the anatomic location of the lesion, which is typically classified as purely ventral (anterior), anterolateral, lateral, posterolateral, or purely posterior. Compared with tumors arising from the thoracic region, cervical meningiomas have a tendency to be located in a ventral position.3,5,7 Even when the physical characteristics of the tumor
Conclusions
The posterolateral approach is effective for treating upper cervical ventral meningiomas. Anterior corpectomy may be useful in cases of single-level, lower cervical tumors. Despite the challenging location of these tumors, the surgical results are satisfying.
References (25)
- et al.
Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management
Surg Neurol
(1996) - et al.
Endoscopic transsphenoidal resection of a mid-clival meningioma
J Clin Neurosci
(2010) - et al.
Surgical management of ventrally based lower cervical (subaxial) meningiomas through the lateral approach: report on 16 cases
Clin Neurol Neurosurg
(2015) - et al.
Spinal cervical meningiomas: the challenge posed by ventral location
World Neurosurg
(2016) - et al.
Hemilaminectomy for spinal meningioma: a case series of 20 patients with a focus on ventral- and ventrolateral lesions
Clin Neurol Neurosurg
(2016) - et al.
Primary intraspinal neoplasms in Norway, 1955 to 1986. A population-based survey of 467 patients
J Neurosurg
(1989) - et al.
Spinal meningiomas: review of 174 operated cases
Neurosurgery
(1989) - et al.
Spinal meningiomas: critical review of 131 surgically treated patients
Eur Spine J
(2008) - et al.
Spinal cord meningioma
J Neurosurg
(1982) - et al.
Spinal meningiomas: surgical management and outcome
Neurosurg Focus
(2003)
Spinal meningiomas in patients younger than 50 years of age: a 21-year experience
J Neurosurg
Surgical management of ventral intradural spinal lesions
J Neurosurg Spine
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Post-laminectomy Dorsal Cord Migration Resulting in Immediate Neurologic Deterioration during Ventral Meningioma Resection: Proposed Mechanism of Injury and Prevention Technique
2022, Journal of Neurological Surgery, Part A: Central European NeurosurgeryTumor occupancy ratio-an imaging characteristic prognosticating the surgical outcome of benign intradural extramedullary spinal cord tumors
2021, International Journal of Spine Surgery
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.