Notani Naoki, Miyazaki Masashi, Kanezaki Shozo, Ishihara Toshinobu, Kawano Masanori, Tsumura Hiroshi
Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan.
Eur J Orthop Surg Traumatol. 2017 Feb;27(2):181-186. doi: 10.1007/s00590-016-1860-1. Epub 2016 Sep 26.
Spinal meningioma is a relatively common tumor among intradural extramedullary spinal tumors. When the locus of the meningioma is located on the ventral side, tumor removal, dura mater resection, and reconstruction via a posterior approach safety become technically difficult.
Twelve patients, who received surgical treatment for ventral spinal meningioma via a posterior approach, were included. There were three male and nine female patients, with an average age of 66.3 years (47-88 years). The average observation period was 55.4 months (22-132 months). In these cases, we analyzed the spinal level of tumor position, histopathological type (subtype), the grade of tumor resection (Simpson grade), pre- and post-operative walking state (Nurick grade), perioperative neurological complications, and the recurrence.
Spinal meningioma occurred in the cervical spinal cord in three cases, with a further nine cases in the thoracic spinal cord. Histopathologically, all 12 tumors were assessed as grade I on the WHO classification system (eight cases of meningothelial type and four cases of psammomatous type). The level of tumor resection was Simpson grade I resection for two cases and Simpson grade II resection for the remaining ten cases. The average of Nurick grade improved from 3.3 preoperatively to 1.3 postoperatively. In all cases, we identified no neurological complications. One incident of tumor recurrence was identified 11 years after an operation involving a Simpson grade II resection CONCLUSION: Posterior approaches provide adequate exposure to safely remove ventrally located meningioma. Posterior exposures with lateral bone resection, dentate ligament division, provide also adequate exposure for safe removal.
脊髓膜瘤是硬脊膜内髓外脊髓肿瘤中相对常见的一种肿瘤。当脑膜瘤位于腹侧时，通过后路进行肿瘤切除、硬脑膜切除及重建在技术上变得困难。
纳入12例经后路手术治疗腹侧脊髓膜瘤的患者。其中男性3例，女性9例，平均年龄66.3岁（47 - 88岁）。平均观察期为55.4个月（22 - 132个月）。在这些病例中，我们分析了肿瘤位置的脊髓节段、组织病理学类型（亚型）、肿瘤切除分级（辛普森分级）、术前和术后行走状态（努里克分级）、围手术期神经并发症及复发情况。
脊髓膜瘤发生于颈段脊髓3例，胸段脊髓9例。组织病理学上，根据世界卫生组织分类系统，所有12例肿瘤均被评估为I级（脑膜内皮型8例，砂粒体型4例）。肿瘤切除程度为辛普森I级切除2例，其余10例为辛普森II级切除。努里克分级的平均值从术前的3.3改善至术后的1.3。所有病例均未发现神经并发症。1例辛普森II级切除术后11年出现肿瘤复发。
后路手术可提供充分暴露以安全切除腹侧脑膜瘤。外侧骨切除、齿状韧带切断的后路暴露也可为安全切除提供充分暴露。
