Posterior Paramedian Approach to Ventrally Located Spinal Meningioma

To approach a ventral spinal pathology, a lateral viewing angle is often required. However, lateral approaches to the spine are usually more technically demanding and require a certain amount of surgical expertise. In this report, we describe a simple and easy technique to obtain the lateral viewing angle to the ventral spinal pathology.

The technique is demonstrated in a ventrally located meningioma at the C2 level. Axial magnetic resonance imaging showed a square posterior shift of the spinal cord with little lateral space, which necessitated a more lateral viewing angle than the conventional posterior approach. With the patient in a prone position, we made a horizontal skin incision at the level of C2 and unilaterally exposed the right side of the C1 and C2 laminae. We then made a small perpendicular incision on the medial portion of the paravertebral muscles, which we retracted longitudinally. This approach provided an unobstructed lateral view toward the spinal cord. Following a gross total removal of the tumor with minimal cord retraction, the patient made an uneventful recovery. Her preoperative neurologic symptoms completely resolved in 2 months. No significant muscle atrophy was observed on postoperative magnetic resonance imaging at 3 months. There was no long-term complication related to the muscle incision at 1-year follow-up.

The posterior paramedian approach is a simple and versatile technique to obtain lateral viewing angle to the spine and useful for approaching lesions residing ventral to the spinal cord.