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Posterior approach to ventrally located spinal meningiomas
Spyridon Voulgaris1, George A Alexiou, Evaggelos Mihos
1Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, Neohoropoulo, 45500, Ioannina, Greece.
Summary
The posterior approach for anterior meningiomas is safe and effective, especially for older patients. Intraoperative monitoring ensures minimal risk of spinal cord injury, leading to successful tumor removal and recovery.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Oncology
Background:
- Anteriorly located meningiomas pose surgical challenges.
- Traditional approaches carry risks, including spinal cord injury.
- The posterior approach is explored as a less invasive alternative.
Purpose of the Study:
- To evaluate the safety and efficacy of the posterior approach for resecting anteriorly located spinal meningiomas.
- To assess the utility of intraoperative monitoring in this procedure.
- To determine patient outcomes and recurrence rates.
Main Methods:
- Ten consecutive patients with spinal meningiomas underwent surgery via a posterior approach.
- Preoperative assessment included neurological exams and imaging (CT, MRI).
- Intraoperative monitoring utilized Transcranial Motor-Evoked Potentials (TcMEPs), Somatosensory-Evoked Potentials (SSEP), and free-running electromyography (EMG).
Main Results:
- All tumors were ventrally located and successfully removed via the posterior approach.
- Free-running EMG monitoring provided surgical alerts for irritation; TcMEP and SSEP remained stable.
- No patients experienced transient or permanent motor deficits postoperatively.
- Histopathology confirmed World Health Organization grade I meningiomas with a low Ki-67/MIB-1 index (mean 2.75%).
Conclusions:
- The posterior approach is a safe and well-tolerated method for resecting anterior spinal meningiomas, particularly in elderly patients.
- Intraoperative monitoring enhances surgical safety and allows for complete tumor excision with satisfactory outcomes.
- Long-term follow-up showed no tumor recurrence or spinal instability.
