Spinal meningioma treatment

Spinal meningioma treatment

Radical resection of spinal meningiomas can be performed with good functional results. Extensive tumor calcification, especially in elderly patients proved to harbor an increased risk for surgical morbidity 1).


Onken et al., reported on their surgical experience that involves two institutions in which 207 patients underwent surgery for spinal meningiomas (sMNGs) . Special focus was placed on patients with sMNGs localized anterior to the denticulate ligament (aMNGs) that were treated via a unilateral posterior approach (ULPA).

The duration of surgery, extent of resection, and outcomes are comparable between aMNGs and posterior to the denticulate ligament (pMNGs) when removed via a ULPA. Thus, ULPA represents a safe route to achieve a gross-total resection, even in cases of aMNG 2).


Posterior approaches provide adequate exposure to safely remove ventrally located spinal meningioma. Posterior exposures with lateral bone resection, denticulate ligament division, provide also adequate exposure for safe removal 3).

Technique

After dural opening, a plane can be developed between the arachnoid and the tumor. The tumor is then internally debulked using suction, an ultrasonic surgical aspirator, microscissors, or laser.

After debulking, in the majority of cases the tumor can be rolled away from the spinal cord and toward its dural attachment.

The tumor is then removed from its dural attachment.

Dura with remaining tumor can be coagulated using bipolar cauterization or resected.

In the majority of cases, the dural attachment was cauterized rather than resected. The dural attachment was always cauterized in cases involving an anterior dural attachment. Additionally, in most cases the dura was closed primarily, compared with suturing in a graft, which was performed far less frequently

Another option was separation of the dura into an outer and inner layer and to resect the tumor with the inner layer, leaving the outer layer available for closure 4).

Videos

References

1)

Sandalcioglu IE, Hunold A, Müller O, Bassiouni H, Stolke D, Asgari S. Spinal meningiomas: critical review of 131 surgically treated patients. Eur Spine J. 2008 Aug;17(8):1035-41. doi: 10.1007/s00586-008-0685-y. Epub 2008 May 15. PubMed PMID: 18481118; PubMed Central PMCID: PMC2518757.
2)

Onken J, Obermüller K, Staub-Bartelt F, Meyer B, Vajkoczy P, Wostrack M. Surgical management of spinal meningiomas: focus on unilateral posterior approach and anterior localization. J Neurosurg Spine. 2018 Dec 1:1-6. doi: 10.3171/2018.8.SPINE18198. [Epub ahead of print] PubMed PMID: 30544344.
3)

Notani N, Miyazaki M, Kanezaki S, Ishihara T, Kawano M, Tsumura H. Surgical management of ventrally located spinal meningiomas via posterior approach. Eur J Orthop Surg Traumatol. 2017 Feb;27(2):181-186. doi: 10.1007/s00590-016-1860-1. PubMed PMID: 27671472.
4)

Gottfried ON, Gluf W, Quinones-Hinojosa A, Kan P, Schmidt MH. Spinal meningiomas: surgical management and outcome. Neurosurg Focus. 2003 Jun 15;14(6):e2. Review. PubMed PMID: 15669787.

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