gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

The posterior approach for spinal meningiomas: Microsurgical technique and recurrences in a series of 61 patients

Der dorsale Zugang zu spinalen Meningeomen: Mikrochirurgische Technik und Rezidivrate in einer Serie von 61 Patienten

Meeting Abstract

  • corresponding author A. Boström - Klinik für Neurochirurgie, Universitätsklinikum der RWTH Aachen, Deutschland
  • F. J. Hans - Klinik für Neurochirurgie, Universitätsklinikum der RWTH Aachen, Deutschland
  • V. Rohde - Klinik für Neurochirurgie, Universitätsklinikum Göttingen, Deutschland
  • T. Krings - Abteilung für Neuroradiologie, Universitätsklinikum der RWTH Aachen, Deutschland
  • J. M. Gilsbach - Klinik für Neurochirurgie, Universitätsklinikum der RWTH Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.01.05

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc207.shtml

Veröffentlicht: 11. April 2007

© 2007 Boström et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: The surgical strategy for spinal meningiomas usually consists of laminectomy, initial tumor debulking, identification of the interface between tumor and spinal cord, resection of the dura including the matrix of the tumor, and duroplasty. The objective of this study was to investigate whether a less invasive surgical strategy consisting of tumor removal and coagulation of the tumor matrix allows comparable clinical results, especially without an increase of the recurrence rate.

Methods: Between 1990 and 2005, 61 patients (11 men, 50 women) underwent surgery for spinal meningioma. All patients were treated microsurgically using a posterior approach. In 56 of the 61 patients, the above outlined – less invasive – surgical technique with tumor removal and coagulation of the tumor matrix was performed. In 5 patients, dura resection and duroplasty was performed in addition. Recurrency was defined as new onset or worsening of symptoms and radiological confirmation of tumor growth. The pre-and postoperative clinical status was measured by the Frankel grade.

Results: Preoperatively, 40 patients were in Frankel grade D, 13 patients in grade C, 6 patients in group E and 1 patient each in group A and B. Following surgery no patient presented a permanent worsening of his clinical symptoms and most patients recovered to a better grade at the time of discharge: 46 patients were in grade D, 13 patients in grade E and 2 patients in grade C. Two patients experienced a temporary worsening of their symptoms, but subsequently improved to a better state than pre-operatively. Two complications (pseudomeningocele, wound infection) (3,3%) requiring surgery, were encountered. The pseudomeningocele developed in a patient, who had undergone durotomy. During the follow-up (mean 8 years), 3 patients (5%) required surgery for symptomatic recurrence: 1 patient had 2 recurrences that occurred 4 and 7 years after tumor removal and matrix coagulation, 1 recurrence occurred 1 year after tumor removal and matrix coagulation in a case with a diffuse anterocranial tumor extension and 1 recurrence occured 3 years after tumor removal and durotomy. 2 patients showed a small recurrence on MRI during follow-up after 2 and 5 years, respectively, but without any symptoms. These did not require surgery so far.

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.