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Minimally invasive surgery for intradural spinal meningioma: A new standard? A comparative study between minimally
C Dauleac1, H-A Leroy2, M-A Karnoub3
1Service de neurochirurgie, hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, Lyon, France; Université de Lyon I, université de Lyon, Lyon, France.
Background:
Some authors used minimally invasive surgery (MIS) in the treatment of spinal cord tumor, but these studies had a small sample sizes and mixed extra- and intra-medullary tumors, resulting in confounding biases. The objectives of the present study were to evaluate the effectiveness and safety of MIS for spinal meningioma resection in comparison with open surgery (OS).
Methods:
Consecutive patients with spinal meningioma who received either MIS or OS were included. Data for extent of resection, functional outcome, postoperative morbidity and recurrence were collected.
Results:
A total of 48 patients (with 51 spinal meningiomas) were included. Eighteen underwent MIS and 30 OS. Meningioma volume and location did not differ significantly between groups: tumors were predominantly thoracic (n=39, 76.5%) and voluminous (occupying more than 50% of the spinal canal: n=43, 84.3%). In the MIS group, patients were older (mean age: 66.5 vs. 56.4years, P=0.02) and more fragile (mean ASA score: 2.0 vs. 1.6, P=0.06). In the MIS group, the surgical procedure was shorter (mean duration: 2.07 vs. 2.56h, P=0.04), blood loss lower (mean: 252 vs. 456mL, P=0.02), and hospital stay shorter (mean: 6.6 vs. 8.1days). Surgery improved the modified McCormick scale (P<0.0001) irrespective of the surgical technique. MIS led to no significant differences in extent of resection or postoperative morbidity. Mean follow-up was 46.6 months. At last follow-up, 91.7% (n=44) of patients were free of progression; all cases of tumor progression (n=4) occurred in the OS group.
Conclusions:
MIS outperformed OS in the management of intradural spinal meningioma, irrespective of location and volume. MIS appears to be particularly suitable for elderly and fragile patients.
Insights
Minimally invasive surgery (MIS) for spinal meningioma offers better outcomes than open surgery (OS), with shorter procedures and hospital stays. MIS is particularly suitable for elderly and fragile patients, showing no significant difference in resection extent or morbidity.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Oncology
Background:
- Previous studies on minimally invasive surgery (MIS) for spinal cord tumors had small sample sizes.
- Mixed inclusion of extra- and intra-medullary tumors in prior research led to confounding biases.
- The effectiveness and safety of MIS for spinal meningioma resection compared to open surgery (OS) required further evaluation.
Purpose of the Study:
- To compare the effectiveness and safety of MIS versus OS for spinal meningioma resection.
- To evaluate functional outcomes, postoperative morbidity, and recurrence rates for both surgical techniques.
Main Methods:
- A comparative study included consecutive patients with spinal meningioma undergoing either MIS or OS.
- Data collected included extent of resection, functional outcome, postoperative morbidity, and recurrence.
- Patient demographics, tumor characteristics (volume, location), and surgical outcomes were analyzed.
Main Results:
- MIS group had shorter surgical duration, lower blood loss, and shorter hospital stays compared to OS.
- Functional outcomes (modified McCormick scale) improved irrespective of surgical technique.
- No significant differences in extent of resection or postoperative morbidity were observed between MIS and OS.
- Tumor progression occurred only in the OS group during a mean follow-up of 46.6 months.
Conclusions:
- Minimally invasive surgery (MIS) is superior to open surgery (OS) for intradural spinal meningioma, regardless of tumor location and volume.
- MIS demonstrated better outcomes in terms of procedure length, blood loss, and hospital stay.
- MIS is particularly advantageous for elderly and fragile patients undergoing spinal meningioma resection.
