Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(03): 744-747
DOI: 10.4103/ajns.AJNS_57_19
Original Article

Combined transpedicular-transarticular approach for ventrally located thoracic intradural meningiomas

Ahmed Balaha
Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta
,
Ebrahim Shamhoot
Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta
› Author Affiliations
› Further Information
Also available at
  Permissions and Reprints

Background: The ventrally located intradural meningiomas in the thoracic spine are still considered a challenge for all spine surgeons. Many surgical approaches were developed to excise the lesion without violating the neural structures. They differ in their invasiveness, safety, and efficacy. One of these approaches is the postero-lateral combined transpedicular-transarticular approach (TPA-TAA). Patients and Methods: From January 2016 to December 2018, all patients with ventrally located thoracic meningiomas were operated on using the combined TPA-TAA. We evaluated all the patients preoperatively, immediate postoperative, and 6 months later. Clinical and functional outcomes were assessed using the muscle strength grade and the Nurick grading system. Magnetic resonance imaging was obtained for all patients postoperative and at 6 months later. Results: After 6 months, all patients experienced clinical and functional improvement. The mean muscle strength grade rose from 3.8 preoperatively to 4.8 after 6 months. According to the Nurick grading system, the mean preoperative grade was 4.4 and dropped to 1.8 after 6 months. Minor transient complications such as superficial wound infection and the cerebrospinal fluid leak were observed in 1 patient for each. Gross total tumor excision was achieved in all patients. No cases of tumor recurrence were noted during the follow-up period. Conclusions: This combined TPA-TAA is considered a safe and effective approach in excising ventrally located intradural thoracic meningiomas with minimal postoperative morbidities.

Key-words:

Spinal meningioma - thoracic spine - transpedicular-transarticular approach

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Gezen F, Kahraman S, Canakci Z, Bedük A. Review of 36 cases of spinal cord meningioma. Spine (Phila Pa 1976) 2000;25:727-31.
  • 2 Klekamp J, Samii M. Surgical results for spinal meningiomas. Surg Neurol 1999;52:552-62.
  • 3 Sandalcioglu IE, Hunold A, Müller O, Bassiouni H, Stolke D, Asgari S. Spinal meningiomas: Critical review of 131 surgically treated patients. Eur Spine J 2008;17:1035-41.
  • 4 Solero CL, Fornari M, Giombini S, Lasio G, Oliveri G, Cimino C, et al. Spinal meningiomas: Review of 174 operated cases. Neurosurgery 1989;25:153-60.
  • 5 Steck JC, Dietze DD, Fessler RG. Posterolateral approach to intradural extramedullary thoracic tumors. J Neurosurg 1994;81:202-5.
  • 6 Gambardella G, Gervasio O, Zaccone C. Approaches and surgical results in the treatment of ventral thoracic meningiomas. Review of our experience with a postero-lateral combined transpedicular-transarticular approach. Acta Neurochir (Wien) 2003;145:385-92.
  • 7 Levy WJ, Latchaw J, Hahn JF, Sawhny B, Bay J, Dohn DF. Spinal neurofibromas: A report of 66 cases and a comparison with meningiomas. Neurosurgery 1986;18:331-4.
  • 8 Peker S, Cerçi A, Ozgen S, Isik N, Kalelioglu M, Pamir MN. Spinal meningiomas: Evaluation of 41 patients. J Neurosurg Sci 2005;49:7-11.
  • 9 Kawahara N, Tomita K, Abdel-Wanis ME, Fujita T, Murakami H, Demura S. Recapping T-saw laminocostotransversoplasty for ventral meningiomas in the thoracic region. J Orthop Sci 2009;14:548-55.
  • 10 Yamahata H, Yamaguchi S, Mori M, Kubo F, Tokimura H, Arita K. Ventral schwannoma of the thoracolumbar spine. Asian Spine J 2013;7:339-44.
  • 11 Lesoin F, Rousseaux M, Lozes G, Villette L, Clarisse J, Pruvo JP, et al. Posterolateral approach to tumours of the dorsolumbar spine. Acta Neurochir (Wien) 1986;81:40-4.
  • 12 Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 1972;95:87-100.
  • 13 Bennett GJ. Surgical approaches to the thoracic spine. Clin Neurosurg 1992;38:234-51.
  • 14 Stillerman CB, Weiss MH. Management of thoracic disc disease. Clin Neurosurg 1992;38:325-52.
  • 15 Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg 1998;88:623-33.
  • 16 Jho HD. Endoscopic microscopic transpedicular thoracic discectomy. Technical note. J Neurosurg 1997;87:125-9.
  • 17 Fessler RG, Dietze DD Jr., Millan MM, Peace D. Lateral parascapular extrapleural approach to the upper thoracic spine. J Neurosurg 1991;75:349-55.
  • 18 Maiman DJ, Larson SJ, Luck E, El-Ghatit A. Lateral extracavitary approach to the spine for thoracic disc herniation: Report of 23 cases. Neurosurgery 1984;14:178-82.
  • 19 Patterson RH Jr., Arbit E. A surgical approach through the pedicle to protruded thoracic discs. J Neurosurg 1978;48:768-72.
  • 20 Richaud J, Boetto S, Lazorthes Y. Posterolateral approach and anterior spinal canal recalibration in severe spinal injury affecting T-12, L-1: A study of seven cases. Neurosurgery 1986;19:218-27.
  • 21 Richaud J, Bousquet P, Ealet G, Clamens J, Beltchika K, Lazorthes Y. Recalibration via a postero-lateral approach in recent traumatic stenosis of the dorsal and lumbar spine. Modalities and results apropos of 31 cases. Neurochirurgie 1990;36:27-38.
  • 22 Roux FX, Nataf F, Pinaudeau M, Borne G, Devaux B, Meder JF. Intraspinal meningiomas: Review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol 1996;46:458-63.
  • 23 Kim CH, Chung CK. Surgical outcome of a posterior approach for large ventral intradural extramedullary spinal cord tumors. Spine (Phila Pa 1976) 2011;36:E531-7.
  • 24 Yoon SH, Chung CK, Jahng TA. Surgical outcome of spinal canal meningiomas. J Korean Neurosurg Soc 2007;42:300-4.