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Novel Dural-Splitting Operative Technique for Excision of Ventrally Located Spinal Meningiomas
Hidehiro Okura1, Omar N Pathmanaban1, David G Munoz1
1Division of Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, Canada.
Objective:
Spinal meningiomas are one of the frequently seen intradural extramedullary spinal tumors. They are almost always World Health Organization grade I, and a complete removal of the tumor can be curative. However, ventrally located spinal meningioma removal can be challenging due to the position in front of the spinal cord through a narrow corridor provided by routine dorsal approaches. Incomplete excision of the relatively inaccessible dural attachment can consequently lead to recurrence. We describe a safe and reproducible technique used to achieve Simpson grade I removal of ventrally located spinal meningioma.
Methods:
Since the spinal dura can be easily divided into inner and outer layers and the tumor usually spares the outer layer, we developed a simple technique to achieve total resection of the tumor and involved dura while leaving the outer dural layer intact.
Results:
An advantage of this procedure is that it exploits an interdural approach to allow early devascularization of the tumor without cord manipulation and provides access to the ventral dura to achieve Simpson grade I excision. Another advantage is complete dural closure to minimize postoperative cerebrospinal fluid leak or ventral cord herniation without the need for dural substitutes.
Conclusion:
Its novel interdural approach can be used for all ages and all spinal meningiomas.
Insights
A novel interdural approach offers safe and complete removal of ventral spinal meningiomas. This technique ensures total tumor resection and dural closure, preventing recurrence and complications.
Area of Science:
- Neurosurgery
- Spinal Oncology
Background:
- Spinal meningiomas are common intradural extramedullary tumors, typically World Health Organization grade I.
- Complete resection is curative, but ventral tumors pose surgical challenges due to anatomical constraints.
- Incomplete excision of ventral spinal meningiomas can lead to tumor recurrence.
Observation:
- A technique was developed to resect ventral spinal meningiomas by dividing the spinal dura into inner and outer layers.
- The tumor and involved inner dural layer are resected while preserving the outer dural layer.
- This method utilizes an interdural approach for early tumor devascularization without spinal cord manipulation.
Findings:
- The interdural approach provides access to the ventral dura for Simpson grade I excision.
- Complete dural closure is achieved, minimizing cerebrospinal fluid leaks and ventral cord herniation.
- The technique allows for safe and reproducible removal of ventrally located spinal meningiomas.
Implications:
- This novel interdural approach is applicable to all ages and spinal meningiomas.
- It offers a safe and effective method for achieving complete resection of challenging ventral spinal tumors.
- The technique enhances surgical outcomes by preventing recurrence and postoperative complications.
