Resection of a ventrally located ossified thoracic spinal meningioma: illustrative case

Abstract

Background: Resection of calcified meningiomas in the ventral thoracic spinal canal remains a formidable surgical challenge despite advances in technology and refined microsurgical techniques. These tumors, which account for a small percentage of spinal meningiomas, are characterized by their hardness, complicating safe resection and often resulting in worse outcomes than their noncalcified counterparts.

Observations: The authors present the case of a 68-year-old woman with a ventrally located ossified meningioma at the T9-10 level, successfully treated via a posterolateral transpedicular approach. Additionally, they conducted a systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, focusing on the origins, imaging findings, surgical strategies, and outcomes of calcified meningiomas in the ventral thoracic spinal canal. Data were extracted and analyzed from 15 articles encompassing 18 cases.

Lessons: Calcified meningiomas in the ventral thoracic spinal canal require meticulous preoperative planning and a tailored surgical approach to optimize outcomes. The posterolateral transpedicular approach offers a balance between adequate exposure and minimizing spinal cord manipulation, making it a viable option for resecting these challenging tumors. A single facetectomy and pediculotomy do not compromise long-term spinal stability. Technological adjuncts, including ultrasonic aspiration, neuromonitoring, and endoscopic assistance, can further enhance surgical safety and effectiveness. https://thejns.org/doi/10.3171/CASE24603.

Keywords: intraoperative monitoring; ossified spinal meningioma; spinal tumor; surgical technique; ventral thoracic spinal canal.

FIG. 1.

The PRISMA flow diagram for the systemic literature review.

FIG. 2.

Preoperative images. Contrast-enhanced sagittal T1-weighted MRI (A) demonstrating an intradural lesion with partial enhancement at the T9–10 level. Sagittal (B) and axial (C) T2-weighed MRI showing a hypointense ventral-based tumor, which displaced the spinal cord dorsally and laterally to the left (green arrow). Sagittal (D) and axial (E) CT with bone settings, revealing the high-density mass within the spinal canal.

FIG. 3.

The patient was placed prone (A) with the skin incision marked on the right side. Intraoperative photograph (B) of an ossified ventral meningioma located eccentrically to the right, displacing the spinal cord toward the left side of the spinal canal. Axial (C) and sagittal (D) postcontrast T1-weighted MRI demonstrating complete tumor resection. Three-dimensional (E) and axial (F) CT showing the surgical corridor (red and blue arrows) with no evidence of a calcified mass. Photomicrographs showing the tumor’s histopathological features: prevalence of psamomma bodies over meningothelial cells (G) and area of osseous metaplasia (H). Hematoxylin and eosin, original magnification ×10. SC = spinal cord; T = tumor.