Novel Dural-Splitting Operative Technique for Excision of Ventrally Located Spinal Meningiomas.

Abstract

BACKGROUND\nSpinal meningiomas are one of the frequently seen intradural extramedullary spinal tumours. They are almost always WHO Grade I and a complete removal of the tumour can be curative. However, ventrally located spinal meningioma removal can be challenging due to the position in front of the spinal cord through a narrow corridor provided by routine dorsal approaches. Incomplete excision of the relatively inaccessible dural attachment can consequently lead to recurrence.\n\n\nOBJECTIVE\nWe describe a safe and reproducible technique used to achieve Simpson Grade I removal of ventrally located spinal meningioma.\n\n\nMETHODS\nSince the spinal dura can be easily divided into inner and outer layers and the tumour usually spares the outer layer, we developed a simple technique to achieve total resection of the tumour and involved dura while leaving the outer dural layer intact.\n\n\nRESULT\nThe advantages of this procedure is that it exploits an interdural approach to allow early devascularization of the tumour without cord manipulation and provides access to the ventral dura to achieve Simpson Grade I excision. Another advantage of this technique is complete dural closure to minimize post-operative CSF leak or ventral cord herniation without the need for dural substitutes.\n\n\nCONCLUSION\nIts novel inter-dural approach can be used for all ages and all spinal meningiomas.