Cao Guangqing, Li Xinao, Wang Dachuan, Zhao Yachao
Department of Spine Surgery, The Second Hospital of Shandong University, Jinan, China.
Front Oncol. 2024 Nov 22;14:1446086. doi: 10.3389/fonc.2024.1446086. eCollection 2024.
This study aimed to evaluate the feasibility and efficacy of one-piece resection for the treatment of ventral intradural extramedullary spinal meningiomas (VIESMs).
Between January 2017 and December 2023, all patients who underwent one-piece resection for VIESMs were retrospectively reviewed with their demographic, intraoperative and postoperative data being recorded. In addition, postoperative neurological status based on the modified McCormick functional schema (mMFS), along with radiological manifestations on the magnetic resonance imaging (MRI) were assessed and compared with that before the operation.
A total of 27 cases (7 men and 20 women) with an average age of 63.37 ± 10.48 years old were included in the present study with the operation time, blood loss, length of hospital stay, and follow-up periods being 292.41 ± 42.64 min, 286.85 ± 47.03 ml, 10.37 ± 1.69 days, and 16.81 ± 10.79 months, respectively. Postoperatively, one case experienced cerebrospinal fluid leakage without neurological deterioration. At the final follow-up, the mMFS scores were unchanged in seven (25.93%) cases while they improved in the remaining 20 (74.07%) cases. Finally, the MRI examinations showed that one-piece resection was successfully performed for each VIESM without a recurrence.
One-piece resection was a feasible, safe and effective procedure for treating VIESMs. Partial removal of the ipsilateral pedicle, facet joint, and even posterior vertebral wall to establish a wide surgical corridor and vision, resection of the dentate ligaments to minimize spinal cord traction, and meticulous coagulation of the dural attachment to reduce recurrence were the key technical points.
本研究旨在评估整块切除术治疗腹侧硬脊膜内髓外脊膜瘤（VIESMs）的可行性和疗效。
回顾性分析2017年1月至2023年12月期间所有接受VIESMs整块切除术的患者，记录其人口统计学、术中及术后数据。此外，根据改良的麦考密克功能量表（mMFS）评估术后神经功能状态，并与术前磁共振成像（MRI）的影像学表现进行比较。
本研究共纳入27例患者（7例男性，20例女性），平均年龄63.37±10.48岁，手术时间、出血量、住院时间和随访时间分别为292.41±42.64分钟、286.85±47.03毫升、10.37±1.69天和16.81±10.79个月。术后，1例患者出现脑脊液漏，但神经功能无恶化。在最后一次随访时，7例（25.93%）患者的mMFS评分未变，其余20例（74.07%）患者的评分有所改善。最后，MRI检查显示每个VIESM均成功进行了整块切除，无复发。
整块切除术是治疗VIESMs的一种可行、安全且有效的方法。部分切除同侧椎弓根、小关节甚至椎体后壁以建立宽敞的手术通道和视野，切除齿状韧带以减少脊髓牵拉，以及仔细凝固硬脑膜附着处以降低复发是关键技术要点。
