Contralateral vs. ipsilateral hemilaminectomy for spinal meningiomas: impact on resection completeness, stability,...

Spinal meningiomas (SMs) account for approximately 25-40% of intradural extramedullary spinal tumors [1]. The classical symptomatology typically begins with pain, followed by motor and/or sensory deficits, gait disturbances, and occasionally bladder or bowel dysfunction [2]. Magnetic resonance imaging (MRI) of the spine is considered the gold standard diagnostic modality [3]. For most symptomatic SMs, the primary treatment is surgical removal of the tumor [3]. In this study, we aimed to evaluate the contralateral posterior hemilaminectomy approach in comparison with the conventional ipsilateral approach, particularly with respect to its potential advantages in preserving spinal stability and achieving more consistent resection.

A retrospective cohort of 64 patients with ventrolateral spinal meningiomas treated between January 2002 and January 2020 was analyzed. Patients were classified by tumor location and surgical approach. Demographics, comorbidities, symptoms, duration, and neurological status were recorded. Neurological function was graded preoperatively and at 1 month postoperatively to evaluate early postoperative functional outcome using the Modified McCormick Scale. The allocation of surgical approach was based on individualized preoperative anatomical assessment by the operating surgeon, without a predefined randomization protocol.

Tumor dimensions and surgical approach did not differ significantly between groups. Facet joint preservation was significantly higher in the contralateral group (80.8% ± 3.8) than in the ipsilateral group (54.6% ± 7.8; p < 0.001). All contralateral cases achieved Simpson Grade II resection versus 63.2% in the ipsilateral group (p = 0.0014). The rate of secondary stabilization was lower in the contralateral group (2/26 vs. 8/38); however, this difference did not reach statistical significance (Fisher's exact p ≈ 0.17) and should be interpreted with caution.

The contralateral approach offers potential advantages in the management of ventrolateral spinal meningiomas, including improved visualization of the ventral dural attachment, more consistent Simpson Grade II resections, and superior facet preservation. The observed difference in secondary stabilization rates did not reach statistical significance and requires prospective validation. Given the inherent constraints of the retrospective design, single tertiary-center surgical team led by the senior author, and absence of formal allocation criteria, these findings should be interpreted as hypothesis-generating rather than definitive. In the context of modern minimally invasive surgery principles, CA may represent a promising stability-sparing alternative for selected ventrolateral SMs.