J Neurosurg Spine. 2021 Jul 30;35(4):516-526. doi: 10.3171/2020.12.SPINE201526. Print 2021 Oct 1.
The authors present an illustrative technical note on microsurgical resection of ventrolateral completely ossified spinal meningiomas (OSMs) and a literature review of the surgical management of calcified spinal meningiomas or OSMs. These tumors are surgically demanding due to their solid consistency, especially when in a ventrolateral location with dislocation of the spinal cord. A challenging case with significant thoracic cord compression and displacement is described. Due to the firm consistency and the ventrolateral localization of the meningioma, a piecemeal resection was necessary. This could have resulted in a free-floating tumor remnant adherent to the spinal cord, impeding safe tumor resection. To avoid such a remnant, an anchoring burr hole was drilled at the border between the spinal cord and the adamantine tumor mass. Then, a microdissector was placed within the anchoring burr hole and the tumor was gently pulled laterally while drilling away the medial parts of the ossified tumor. This procedure was repeated until separation of the tumor from the spinal cord was possible and a gross-total resection (Simpson grade II) was manageable. Throughout the procedure, continuous intraoperative neurophysiological monitoring was performed.
作者介绍了一例经显微外科切除完全骨化的脊髓侧方脑膜瘤（OSS）的实例，并对钙化性脊柱脑膜瘤或 OSM 的手术治疗进行了文献复习。这些肿瘤由于质地坚硬，尤其是位于脊髓侧方并伴有脊髓脱位时，手术难度较大。本文描述了一例具有挑战性的严重胸段脊髓压迫和移位的病例。由于脑膜瘤质地坚硬且位于侧方，因此需要分块切除。这可能导致游离的肿瘤残块附着在脊髓上，妨碍安全切除肿瘤。为了避免这种残块，在脊髓和坚硬肿瘤团块的交界处钻一个锚固颅钻孔。然后，将微型解剖器置于锚固颅钻孔内，并在钻孔去除骨化肿瘤的内侧部分的同时，将肿瘤轻轻向外侧牵拉。这个过程重复进行，直到肿瘤可以与脊髓分离，并且可以进行大体全切（Simpson 分级 II）。在整个手术过程中，持续进行术中神经生理监测。
