Minimally invasive surgery for benign intradural extramedullary spinal meningiomas: experience of a single institution in a cohort of elderly patients and review of the literature

Abstract

Meningiomas of the spine are the most common benign intradural extramedullary lesions and account for 25%-46% of all spinal cord tumors in adults. The goal of treatment is complete surgical resection while preserving spinal stability. Usually, these lesions occur in the thoracic region and in middle-aged women. Clinical presentation is usually nonspecific and the symptoms could precede the diagnosis by several months to years, especially in older people, in whom associated age-related diseases can mask the tumor for a long time. We report a series of 30 patients, aged 70 years or more, harboring intradural extramedullary spinal meningiomas. No subjects had major contraindications to surgery. A minimally invasive approach ( hemilaminectomy and preservation of the outer dural layer) was used to remove the tumor, while preserving spinal stability and improving the watertight dural closure. We retrospectively compared the outcomes in these patients with those in a control group subjected to laminectomy or laminotomy with different dural management. In our experience, the minimally invasive approach allows the same chances of complete tumor removal, while providing a better postoperative course than in a control group.

Keywords: elderly; hemilaminectomy; inner dural layer; minimally invasive surgery; outer dural layer; spinal meningioma.

Figure 1

Illustrative case 1. (A–C) Preoperative axial, sagittal, and coronal magnetic resonance images showing a right upper cervical spine meningioma. (D) Postoperative computed tomography scan showing the unilateral approach. (E and F) Postoperative MRI demonstrating complete removal of the lesion.

Figure 2

Illustrative case 2. (A and B) Preoperative axial and sagittal magnetic resonance images showing a meningioma of the thoracolumbar junction. (C and D) Postoperative axial and coronal computed tomographic scan demonstrating the minimally invasive unilateral approach. (E) Postoperative magnetic resonance image showing complete tumor resection.

Figure 3

Intraoperative images. (A and B) Intraoperative evidence of two dural layers with the spinal meningioma attachment to the inner layer. (C) Final view demonstrating the preserved outer dural layer as well as complete removal of the lesion together with the inner dural layer.