Microscopic Keyhole Surgery For Resection Of Meningiomas Located In The Ventral Of Thoracic Spinal Cord Via An Oblique Placing Tube

Objective: To present the technique and clinical outcomes of microscopic keyhole surgery for resection of meningiomas located in the ventral of thoracic spinal cord via an oblique placing tube.Materials and methods: Retrospectively analyzed the data of 11 cases with thoracic spinal meningioma who have received the surgery mentioned above in a single center from Jan.2015 to Jan.2019.For specific surgical technique,an oblique tube system sized 1.8 to 2.5cm is placed percutaneously at the affected side 2.5 to3.5cm laterally to the spinous via which hemilaminectomy and hemifacetectomy are performed.Then cut open the dura trending to the lateral and ventral side.Afterwards,the tumor will be clearly exposed and completely removed.Remove the tube system after suturing the dura,then suture all individual layers of muscle and fascia using absorbable sutures,close up the incision tightly,no drainage tube was needed.Results: The tumors were excised completely in all 11 cases.Among all the cases,there were 1 male case and 10 female cases,with age of(57±14).The size of tumors range from 1.3cm×0.5cm×0.5cmm to 2.5×1.5×1.0cm.Postoperational pathological results showed that 3 were psammomatous meningiomas,3 were transitional meningiomas and the rest 5 were meningiotheliomatous meningiomas.The average surgical time was(146.8±19.2)min,the average amount of intraoperative blood loss was(61.4±27.7)ml.No complications such as infection,CSF leakage or Aggravation of spinal cord injury occurred in all cases.The average of postoperative length of stay was(5.3±1.0)d.The length of follow-up periods range from 9 to 50 months with an average at(28.1±14.0)months.The average of value of VAS score before operation was(6.36±1.12).The average of value of VAS score at discharge was(0.91±0.70).The average of value of VAS score at the follow-up 6 months after operation was(0.54±0.99).improving significantly comparing to the mean preoperative VAS score which was(6.36±1.12)(P<0.05).With K-W test,there were significant comparing in neurological function scores before operation,at discharge and at the follow-up 6 months after operation(P<0.01).Further pairwise comparison results showed that after operation the neurological function of spinal cord was basically improved(Z=-2.877,P<0.05).Neither tumor recurrence nor impairment of spinal stability was observed during the whole follow-up period.Conclusion: This study illustrated the effectiveness and safety of percutaneous keyhole thoracic spinal ventral meningioma excision under oblique micro canal,and the clinical effect was safe and satisfactory.