Article
Spinal meningeomas: Surgical technique, operative results and recurrences in a consecutive series of 48 patients
Spinale Meningeome: Operationstechnik, Ergebnisse und Rezidive in einer Serie von 48 Patienten
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Published: | April 23, 2004 |
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Outline
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Objective
The surgical strategy for spinal meningiomas usually consists of laminectomy, initial tumor debulking, identification of the interface of tumor and spinal cord, resection of the dura including the matrix of the tumor, and duroplasty. The objective of the study is to investigate if a less invasise surgical strategy, which is reduced to hemilaminectomy, tumor removal and coagulation of the tumor matrix allows comparable surgical results to be obtained without an increase of the recucurrence rate.
Methods
Between 1990 and 2001, 48 patients (10 men, 38 women) underwent first surgery for a spinal meningioma. In 43 of the 48 patients, the above outlined - less invasive surgical - technique with hemilaminectomy, tumor removal and coagulation of the tumor matrix was performed. In 5 patients, dura resection and duroplasty was additionally done. Electrophysiological monitoring has routinely been used since 1996. Recurrency was defined as new onset or worsening of symptoms and radilogical confirmation of tumor growth at the tumor former site.
Results
In 46 of the 48 patients (96%) improvement of the preoperative symptoms (motor deficit n=31, sensory deficit n=29, ataxia n=19, pain n=10) could be observed during the hospital stay. Two patients experienced a temporary symptom worsening, but improved later to a better than pre-operative state. Two complications (pseudomeningocele, wound infection) (4%) requiring surgery, were encountered. The pseodomeningocele developed in a patient who underwent durotomy. During the follow-up period of 8 years (mean), 2 patients (4%) required surgery for symptomatic recurrence; one recurrence occured 7 years after tumor removal and matrix coagulation, the other 3 years after tumor removal and durotomy.
Conclusions
The high rate of favorable clinical results combined with the low rate of recurrences supports our less invasive surgical concept, which does not aim for resection of the dural matrix of the spinal meningioma.