Artikel
Management of anterior to denticulate ligament meningiomas of the spinal canal
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Autoren
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Julia Onken
- Charité - Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Kathrin Obermüller
- Technische Universität München, Klinikum rechts der Isar, Neurochirurgie, München, Deutschland
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Bernhard Meyer
- Technische Universität München, Klinikum rechts der Isar, Neurochirurgie, München, Deutschland
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Peter Vajkoczy
- Charité - Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Maria Wostrack
- Technische Universität München, Klinikum rechts der Isar, Neurochirurgie, München, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: In this study, we report on our experience of two institutions performing surgery on 207 patients with a spinal meningioma. Special consideration was focused on patients with spinal meningioma localized anterior to the denticulate ligament (aMNG) in the spinal canal, which have been approached via a minimal-invasive, unilateral posterior approach (ULPA). aMNG represent a surgically challenging subgroup. In literature, these meningiomas are regarded with high perioperative complication rate due to complex surgical approaches.
Methods: Between 2005 and 2017, 207 patients with histological confirmation of spinal meningioma underwent surgical resection in both institutions. Patients were analyzed regarding tumor size and localization, surgical approach, duration of surgery, grade of resection, peri- and postoperative complication rate and neurological outcome. Data was compared between the subgroups of meningioma according to their localization to the denticulate ligament and surgical approach.
Results: We identified fifty-eight patients with anterior (aMNG) and eighty patients with posterior located meningioma (pMNG). 55% of aMNG and 64% of pMNG were approached from a minimal-invasive ULPA. Among these cases, no difference in complication rate and outcome was seen. Gross total resection (GTR) was accomplished in 93% of aMNG and in 92% of pMNG. Surgical complication rate was 6% in aMNG versus 5% in pMNG including CSF fistula, wound healing problems, and bleeding. Postoperatively, 97% of patients with aMNG showed stable or improved neurological function versus 99% in pMNG. aMNG, which have been approach from a minimal-invasive ULPA showed less long duration of surgery (131 vs. 224 minutes, p<0.0001), fewer surgical complication rate (9% vs. 12%, p=ns) and improved neurological outcome (98% vs. 88%, p=0.0003) compared to those who have been approached from a bilateral dorsal approach (BLPA).
Conclusion: Duration of surgery, resection grade and outcome is comparable between aMNG and pMNG, when removed from a minimal-invasive ULPA. Thus, minimal-invasive ULPA represents a save method to archive GTR even in aMNG and shows superior results compared to BLPA. GTR is achievable in >90% of cases and provides sufficient control of tumor recurrence.
