Avoidance of structural pitfalls in spinal meningioma resection

Creating a surgical avenue through which to resect an intraspinal meningioma requires dissection of the musculoligamentous structures of the spine. Variable vertebral components must be removed to create a corridor to the intraspinal compartment. The cardinal principles of intraspinal tumor resection are to minimize the intraoperative risk of deformation and traumatic injury of the spinal cord. Therefore, the appropriate planning for access to and removal of the osseous elements is critical. Of equal importance is the consideration of the biomechanics of the spine. In cases of potential spinal instability instrumentation-assisted fusion should be performed at the time of tumor resection. The authors discuss the techniques for creating access to these tumors and propose a simple classification scheme to assist with this decision-making process.