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Spinal Cervical Meningiomas: The Challenge Posed by Ventral Location
Nicolas Lonjon1, Vittorio Russo2, Manlio Barbarisi2
1Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier, France; National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
World Neurosurgery
|February 7, 2016
Summary
Spinal meningiomas require advanced microsurgical techniques for optimal outcomes. Complete tumor resection, particularly using the far-lateral approach for ventral tumors, is crucial for decreasing recurrence risk and improving patient prognosis.
Area of Science:
- Neurosurgery
- Oncology
- Spinal Surgery
Background:
- Spinal meningiomas are typically benign tumors.
- Cervical spinal meningiomas present unique surgical challenges due to their location.
- Advances in imaging and microsurgery have improved treatment outcomes.
Purpose of the Study:
- To evaluate the incidence, clinical presentation, operative techniques, and long-term outcomes of cervical spinal meningiomas.
- To assess the efficacy of different surgical approaches for spinal meningiomas.
- To determine factors influencing recurrence and patient prognosis.
Main Methods:
- Retrospective analysis of 22 patients with cervical spinal meningiomas treated between 2004 and 2014.
- Diagnosis confirmed by magnetic resonance imaging (MRI) and histology.
- Microsurgical resection using posterior, far-lateral, and combined approaches based on tumor location.
Main Results:
- Mean follow-up of 40 months.
- Ventral or ventrolateral dural attachment was most common.
- Complete macroscopic resection achieved in 55% of cases.
- Neurologic improvement observed in 60% of patients.
- High operative mortality and morbidity rate (26.5%).
- Overall recurrence rate of 9% after surgery and radiotherapy in select cases.
Conclusions:
- Total resection of spinal meningiomas is essential for reducing recurrence risk.
- The far-lateral approach is advocated for managing anteriorly located meningiomas.
- Cervical spinal meningiomas, especially ventrally located ones, pose significant surgical challenges.
- Despite challenges, microsurgical techniques offer improved outcomes for these benign tumors.
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