Technical Feasibility And Therapeutic Analysis Of En-bloc Resection Of Ventral Intradural Extramedullary Meningiomas

BackgroundSpinal meningiomas,common intradural spinal tumors,are evident among elder people,occurring with highest frequency in thoracic region.They arise from arachnoidal cap cells or fibroblast of spinal dural.Slow growing as spinal meningiomas are,considerable compressive forces could be exerted on the spinal cord,which could lead to focal pain,motor weakness,sensory loss,even ataxic gait or bowel and bladder dysfunction.Conservative treatment is not satisfactory for spinal meningiomas,while safe,complete resection with a favorable outcome is possible in most cases.Piecemeal resection now cannot correspond to the demang of oncology with high recurrence rate.The en-bloc resection of dorsal meningiomas is easy to be achieved and has less influnce to the spinal cord than the resection of ventral tumors,lower recurrence rate than the piecemeal resection.The ventral meningiomas are common to see and they are in the deeper space of the spinal canal.The feasibility of en-bloc resection of the ventral meningiomas remains to be discussing at the technical level.ObjectiveTo discuss the technical feasibility and therapeutic outcome of En-bloc resection of the ventral intradural extramedullary spinal meningiomas.MethodsThe clinical and radiological details of patients,who underwent surgery for spinal tumors in department of Spinal surgery between 2012 and 2016 that were histopathologically confirmed as meningiomas,were retrospectively reviewed.Assessing the outcome of total en-bloc surgery by analysing clinical manifestation,radiological parameters and neurological condition before and after operation.ResultsA total of 30 patients were included in this study.There were 1 epidural meningioma and 30 intradural tumors,among which 16(53.3%)cases were classified as ventral attachment and the other 14(46.7%)cases were dorsal attachment.There were 3 male and 28 female patients with a mean age of 61.9 ± 13.1 years.Most of the intradural meningiomas(23 cases,74.2%)were located in thoracic region.The number of patients before surgery in McCormick Grades I,II,III,and IV were 4(12.9%),7(25.8%),10(32.3%),9(29.0%),and the number postoperative were 14(48.4%),11(38.7),5(12.9%)and 0(0.0%),retrospectively.Overall neurological assessment after surgery revealed the satisfactory on McCormick functional schema.No recurrence case was found at a mean follow-up 15.6 months.ConclusionIntradural extramedullary meningiomas are typically benign,slow-growing tumors,which could gradually cause significant neurological deficits.The En-bloc resection could be implied on most of the intradural meningiomas while keeping neurological function preserved and with no recurrence.With the study of the design and technical feasibility,the en-bloc resection of ventral intradural extramedullary spinal meningiomas is practicible.In the clinical contral study,the outcome of ventral meningiomas is quite semblable to the doral tumors,which gives reliable clinical support to the en-bloc resection of ventral meningiomas.