Posterior approach to ventrally and dorsally located spinal meningiomas
https://doi.org/10.14531/ss2021.1.61-69
Abstract
Objective. To analyze the outcomes of posterior approach in the surgery of intradural extramedullary meningiomas located ventrally and dorsally in relation to the spinal cord denticulate ligaments.
Material and Methods. The study included 29 patients with spinal intradural meningiomas operated on using posterior approach. Patients were divided depending on the tumor location relative to the denticulate ligaments into ventral (n = 13) and dorsal (n = 16) groups. The surgery duration, the degree of tumor resection, clinical outcomes, the presence and nature of complications, and the frequency of recurrence were assessed.
Results. The average follow-up period was 29 (6 to 61) months. Total tumor removal was performed in 93.1 % of cases: 11 cases (84.6 %) in ventral group and 16 cases (100.0 %) in dorsal group. The average duration of surgery was 136 minutes for dorsal meningiomas and 181 minutes for ventral meningiomas (p < 0.05). Complications in the form of CSF leakage were registered in two patients (6.9 %). In 11 (84.6 %) patients with ventral meningiomas and 15 (93.7 %) patients with dorsal meningiomas, an improvement or preservation of neurological functions at the pre-surgery level was observed. Recurrences were observed in two patients (6.9 %).
Conclusion. Patients with spinal meningiomas have a favorable neurological outcome and a low recurrence rate. Surgery is more complicated in patients with ventral meningiomas. In most cases, unilateral posterior approach is applicable for both ventral and dorsal meningiomas.
About the Authors
G. B. Grygoriev
Pavlov First St. Petersburg State Medical University
6–8 L’va Tolstogo str., St. Petersburg, 197022, Russia
Russian Federation
Russian Federation
neurosurgeon, Neurosurgery Department
V. Yu. Cherebillo
Pavlov First St. Petersburg State Medical University
6–8 L’va Tolstogo str., St. Petersburg, 197022, Russia
Russian Federation
Russian Federation
DMSc, Prof., head of the Chair of Neurosurgery
D. V. Goranchuk
Pavlov First St. Petersburg State Medical University
6–8 L’va Tolstogo str., St. Petersburg, 197022, Russia
Russian Federation
Russian Federation
head of the Neurosurgery Department
References
1. Helseth A, Mork SJ. Primary intraspinal neoplasms in Norway, 1955 to 1986. A population-based survey of 467 patients. J Neurosurg. 1989;71:842–845. DOI 10.3171/jns.1989.71.6.0842.
2. Onken J, Obermuller 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;30:308–313. DO 10.3171/2018.8.SPINE18198.
3. Riad H, Knafo S, Segnarbieux F, Lonjon N. Spinal meningiomas: surgical outcome and literature review. Neurochirurgie. 2013;59:30–34. DOI: 10.1016/j.neuchi.2012.10.137.
4. Ambekar S, Sharma M, Kukreja S, Nanda A. Complications and outcomes of surgery for spinal meningioma: a Nationwide Inpatient Sample analysis from 2003 to 2010. Clin Neurol Neurosurg. 2014;118:65–68. DOI: 10.1016/j.clineuro.2013.12.010.
5. Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E, Deimling A, Stavrinou P, Lefranc F, Lund-Johansen M, Moyal ECH, Brandsma D, Henriksson R, Soffietti R, Weller M. EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol. 2016;17:383–391. DOI: 10.1016/S1470-2045(16)30321-7.
6. Gottfried ON, Gluf W, Quinones-Hinojosa A, Kan P, Schmidt MH. Spinal meningiomas: surgical management and outcome. Neurosurg Focus. 2003;14:e2. DOI 10.3171/foc.2003.14.6.2.
7. Bydon M, Gokaslan ZL. Spinal meningioma resection. World Neurosurg. 2015;83:1032–1033. DOI: 10.1016/j.wneu.2015.01.049.
8. Sun SQ, Cai C, Ravindra VM, Gamble P, Yarbrough CK, Dacey RG, Dowling JL, Zipfel GJ, Wright NM, Santiago P, Robinson CG, Schmidt MH, Kim AH, Ray WZ. Simpson grade I–III resection of spinal atypical (World Health Organization grade II) meningiomas is associated with symptom resolution and low recurrence. Neurosurgery. 2015;76:739–746. DOI: 10.1227/NEU.0000000000000720.
9. Setzer M, Vatter H, Marquardt G, Seifert V, Vrionis FD. Management of spinal meningiomas: surgical results and a review of the literature. Neurosurg Focus. 2007;23:E14. DOI: 10.3171/FOC-07/10/E14.
10. Tsuda K, Akutsu H, Yamamoto T, Nakai K, Ishikawa E, Matsumura A. 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). 2014;54:907–913. DOI: 10.2176/nmc.oa.2013-0311.
11. Yamamuro K, Seichi A, Kimura A, Kikkawa I, Kojima M, Inoue H, Hoshino Y. Histological investigation of resected dura mater attached to spinal meningioma. Spine. 2012;37:E1398–1401. DOI: 10.1097/BRS.0b013e318268c419.
12. Klekamp J, Samii M. Surgery of Spinal Tumors. Springer-Verlag Berlin Heidelberg. 2007:248–259.
13. Boström A, Bürgel U, Reinacher P, Krings T, Rohde V, Gilsbach JM, Hans FJ. A less invasive surgical concept for the resection of spinal meningiomas. Acta Neurochir (Wien). 2008;150:551–556. DOI: 10.1007/s00701-008-1514-0.
14. Angevine PD, Kellner C, Haque RM, McCormick PC. Surgical management of ventral intradural spinal lesions. J Neurosurg Spine. 2011;15:28–37. DOI 10.3171/2011.3.SPINE1095.
15. Klekamp J, Samii M. Introduction of a score system for the clinical evaluation of patients with spinal processes. Acta Neurochir (Wien). 1993;123:221–223.
16. Lonjon N, Russo V, Barbarisi M, Choi D, Allibone J, Casey A. Spinal cervical meningiomas: the challenge posed by ventral location. World Neurosurg. 2016;89:
17. –473. DOI: 10.1016/j.wneu.2016.01.029.
18. Takami T, Naito K, Yamagata T, Yoshimura M, Arima H, Ohata K. Posterolateral approach for spinal intradural meningioma with ventral attachment. J Craniovertebr Junction Spine. 2015;6:173–178. DOI: 10.4103/0974-8237.167862.
19. Aboul-Enein HA, Khidr WM, Abdeen KM, Madawi AA. Surgical management of ventrally based lower cervical (subaxial) meningiomas through the lateral approach: report on 16 cases. Clin Neurol Neurosurg. 2015;139:152–158. DOI: 10.1016/j.clineuro.2015.10.008.
20. Steck JC, Dietze DD, Fessler RG. Posterolateral approach to intradural extramedullary thoracic tumors. J Neurosurg. 1994;81:202–205. DOI: 10.3171/jns.1994.81.2.0202.
21. Gezen F, Kahraman S, Canakci Z, Beduk A. Review of 36 cases of spinal cord meningioma. Spine. 2000;25:727–731. DOI: 10.1097/00007632-200003150-00013.
22. 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;27:181–186. DOI: 10.1007/s00590-016-1860-1.
23. Усанов Е.И., Коваленко Р.А., Простомолотов М.Н. Удаление опухолей спинного мозга и конского хвоста из интерламинэктомического доступа // Нейрохирургия. 2013. № 4. С. 75–78. DOI: 10.17650/1683-3295-2013-0-4-75-78. [Usanov EI, Kovalenko RA, Prostomolotov MN. The remuval of spinal tumors and tumors of cauda equina via interlaminectomy approach. Russian Journal of Neurosurgery. 2013;(4):75–78. In Russian].
24. Conti P, Pansini G, Mouchaty H, Capuano C, Conti R. Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature. Surg Neurol. 2004;61:34–43. DOI: 10.1016/s0090-3019(03)00537-8.
25. Yoon SH, Chung CK, Jahng TA. Surgical outcome of spinal canal meningiomas. Korean Neurosurg Soc. 2007;42:300–304. DOI: 10.3340/jkns.2007.42.4.300.
26. Kim CH, Chung CK. Surgical outcome of a posterior approach for large ventral intradural extramedullary spinal cord tumors. Spine. 2011;36:E531–E537. DOI: 10.1097/BRS.0b013e3181dc8426.
27. Tola S, De Angelis M, Bistazzoni S, Chiaramonte C, Esposito V, Paolini S. Hemilaminectomy for spinal meningioma: a case series of 20 patients with a focus on ventral- and ventrolateral lesions. Clin Neurol Neurosurg. 2016;148:35–41. DOI: 10.1016/j.clineuro.2016.06.015.
28. Arima H, Takami T, Yamagata T, Naito K, Abe J, Shimokawa N, Ohata K. Surgical management of spinal meningiomas: a retrospective case analysis based on preoperative surgical grade. Surg Neurol Int. 2014;5(Suppl 7):S333–S338. DOI: 10.4103/2152-7806.139642.
29. Пташников Д.А., Усиков В.Д. Результаты хирургического лечения больных с доброкачественными опухолями позвоночника // Хирургия позвоночника. 2005. № 4. С. 61–65. [Ptashnikov DA, Usikov VD. Results of surgical treatment of patients with benign tumors of the spine. Hir. Pozvonoc. 2005;(4):61–65. In Russian]. DOI: 10.14531/ss2005.4.61-65.
30. Григорьев Г.Б., Шулев Ю.А., Трашин А.В. Опухоли оболочек нервов шейного отдела позвоночника: риск развития неврологического дефицита при резекции пораженного нервного корешка // Российский нейрохирургический журнал им. проф. А.Л. Поленова. 2015. Т. VII. № 3. C. 46–51. [Grygoriev GB, Shulev YuA, Trashin AV. Nerve sheath tumors of the cervical spine: risk of neurological deficit after resection of involved nerve root. Russian Neurosurgical Journal n.a. Professor Polenov. 2015;7(3):46–51. In Russian].
31. Шулев Ю.А., Григорьев Г.Б., Трашин А.В. Анализ исходов хирургического лечения эпендимом терминальной нити // Российский нейрохирургический журнал им. проф. А.Л. Поленова. 2016. Т. VIII. № 1. C. 49–55. [Shulev YuA, Grygoriev GB, Trashin AV. Outcome analysis after surgical treatment of filium terminale ependymomas. Russian Neurosurgical Journal n.a Professor Polenov. 2016;8(1):49–55. In Russian].
32. Nakamura M, Tsuji O, Fujiyoshi K, Hosogane N, Watanabe K, Tsuji T, Ishii K, Toyama Y, Chiba K, Matsumoto M. Long-term surgical outcomes of spinal meningiomas. Spine. 2012;37:E617–623. DOI: 10.1097/BRS.0b013e31824167f1.
33. Solero CL, Fornari M, Giombini S, Lasio G, Oliveri G, Cimino C, Pluchino F. Spinal meningiomas: review of 174 operated cases. Neurosurgery. 1989;25:153–160. DOI: 10.1227/00006123-198908000-00001.
34. Voulgaris S, Alexiou GA, Mihos E, Karagiorgiadis D, Zigouris A, Fotakopoulos G, Drosos D, Pahaturidis D. Posterior approach to ventrally located spinal meningiomas. Eur Spine J. 2010;19:1195–1199. DOI: 10.1007/s00586-010-1295-z.
35. Roux FX, Nataf F, Pinaudeau M, Borne G, Devaux B, Meder JF. Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol. 1996;46:458–463. DOI: 10.1016/s0090-3019(96)00199-1.
36. Sandalcioglu IE, Hunold A, Muller O, Bassiouni H, Stolke D, Asgari S. Spinal meningiomas: critical review of 131surgically treated patients. Eur Spine J. 2008;17:1035–1041. DOI: 10.1007/s00586-008-0685-y.
37. Durand A, Labrousse F, Jouvet A, Bauchet L, Kalamarides M, Menei P, Deruty R, Moreau JJ, Fevre-Montange M, Guyotat J. WHO grade II and III meningiomas: a study of prognostic factors. J Neurooncol. 2009;95:367–375. DOI: 10.1007/s11060-009-9934-0.
38. Maiti TK, Bir SC, Patra DP, Kalakoti P, Guthikonda B, Nanda A. Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome. Neurosurg Focus. 2016;41:E6. DOI: 10.3171/2016.5.FOCUS16163.
39. Westwick HJ, Shamji MF. Effects of sex on the incidence and prognosis of spinal meningiomas: a Surveillance, Epidemiology, and End Results study. J Neurosurg Spine. 2015;23:368–373. DOI: 10.3171/2014.12.SPINE14974.
40. Gilard V, Goia A, Ferracci FX, Marguet F, Magne N, Langlois O, Perez A, Derrey S. Spinal meningioma and factors predictive of post-operative deterioration. J Neurooncol. 2018;140:49–54. DOI: 10.1007/s11060-018-2929-y.
Review
For citations:
Grygoriev G.B., Cherebillo V.Yu., Goranchuk D.V. Posterior approach to ventrally and dorsally located spinal meningiomas. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2021;18(1):61-69. https://doi.org/10.14531/ss2021.1.61-69
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