Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee, USA.
World Neurosurg. 2021 Nov;155:94-95. doi: 10.1016/j.wneu.2021.08.083. Epub 2021 Aug 26.
Spinal meningiomas constitute 10% of all meningiomas. They most commonly rise in the thoracic spine and are most common in middle aged women; symptoms include progressive myelopathy. Radiation induced/radiotherapy-associated cranial meningiomas are well described with aggressive behavior; however, radiation-induced spinal meningiomas are extremely rare in the literature. Our patient had a history of Hodgkin lymphoma treated with neck radiation, and thyroid cancer treated with radioactive iodine/thyroidectomy. He presented with neck pain and myelopathy from a large intradural, extramedullary tumor compressing the spinal cord (C3-C5). He had a prevertebral phlegmon that was resolved with antibiotics prior to surgery. Intraoperative neurophysiological electrodes were placed for somatosensory-evoked potential and motor-evoked potential monitoring. C3-C5 bilateral laminectomies were performed (Video 1); dura was incised over the tumor. Tumor attachments to the dura were coagulated and divided. The tumor was dissected microsurgically from the spinal cord and nerve roots. The dural layer involved by the tumor was split and resected from the uninvolved dura, achieving tumor resection. Postoperatively, the patient's myelopathy resolved. He has been followed for a 1 year now with mangetic resonance imaging scans of the cervical spine ± contrast every 6 months. To our knowledge, this is the first operative video describing resection of a spinal meningioma, which happens to be radiation-induced, using a dural splitting technique to achieve better resection and prevent tumor recurrence. The alternative treatment would be to leaving the inner layer of dura, coagulation, or excising both layers and performing duraplasty. Both alternative options, however, would increase the risk of recurrence and spinal fluid leak. Cervical spine meningiomas with spinal cord compression and myelopathy should be resected to prevent further neurological decline. Dural splitting can be utilized to achieve "radical" tumor resection to prevent recurrence, which is particularly important if the tumor is aggressive and recurrent, as is the case in radiation-induced/radiotherapy-associated meningiomas. Upon dural closure, we applied autologous fat tissue along with fibrin glue to avoid spinal fluid leak as we published earlier. The patient consented to the procedure and publication of his image.
脊髓脑膜瘤占所有脑膜瘤的 10%。它们最常发生在胸椎，多见于中年女性；症状包括进行性脊髓病。放射性诱导/放疗相关颅脑膜瘤具有侵袭性行为，已有相关描述；然而，文献中极少见放射性诱导的脊髓脑膜瘤。我们的患者患有霍奇金淋巴瘤，曾接受颈部放疗，甲状腺癌，接受放射性碘/甲状腺切除术治疗。他因颈椎（C3-C5）硬膜内、外髓外的大型肿瘤压迫脊髓而出现颈部疼痛和脊髓病。他有一个椎前筋膜炎，在手术前用抗生素治愈。术中放置了用于体感诱发电位和运动诱发电位监测的神经生理电极。进行了 C3-C5 双侧椎板切除术（视频 1）；切开肿瘤上方的硬脑膜。肿瘤与硬脑膜的附着处被烧灼和分离。肿瘤从脊髓和神经根上被显微镜下分离。受肿瘤累及的硬脑膜层从未受累的硬脑膜层中分离并切除，实现肿瘤切除。术后，患者的脊髓病得到缓解。现在他已经接受了 1 年的随访，包括颈椎磁共振成像扫描±每 6 个月进行对比检查。据我们所知，这是第一个描述使用硬脑膜分离技术切除脊髓脑膜瘤的手术视频，该手术恰好是放射性诱导的，以实现更好的切除并预防肿瘤复发。另一种治疗方法是保留硬脑膜内层、烧灼或切除两层并进行硬脑膜成形术。然而，这两种替代方案都会增加复发和脑脊液漏的风险。对于有脊髓压迫和脊髓病的颈椎脑膜瘤，应进行切除以防止进一步的神经功能下降。硬脑膜分离可用于实现“根治性”肿瘤切除，以预防复发，如果肿瘤具有侵袭性和复发性，如放射性诱导/放疗相关脑膜瘤，则尤其重要。在硬脑膜关闭时，我们如之前发表的文章中所述，应用自体脂肪组织和纤维蛋白胶，以避免脑脊液漏。患者同意进行该手术并同意发表其图像。
