Posterolateral Approach for Recurrent Multi-Level Ventral Intradural Extramedullary Cervical Spinal Meningioma

Spinal meningiomas are common intradural spinal tumors. Recurrent multilevel ventral intradural extramedullary spinal meningiomas, especially those presenting several years post-initial surgery is rare and can be particularly challenging to treat. We report two cases of such recurrent multilevel ventral tumors manifesting 7 and 20 years after the initial procedure. These patients were effectively managed through a posterolateral approach, encompassing laminectomy, facetectomy, division of dentate ligament with spinal cord rotation, and instrumented fusion. While the choice of surgical approach should be individualized based on the tumor and patient?s characteristics and the surgeon?s expertise, our experience with these cases continues to show the safety and efficacy of posterior-based approaches highlighting the additional and important surgical modifications for multilevel recurrent ventral intradural meningiomas.