Spinal meningiomas

Spinal Meningiomas: A Comprehensive Review and Update on Advancements in Molecular Characterization, Diagnostics, Surgical Approach and Technology, and Alternative Therapies

Spinal meningiomas are the most common intradural, extramedullary tumor in adults, yet the least common entity when accounting for all meningiomas spanning the neuraxis. While traditionally considered a benign recapitulation of their intracranial counterpart, a paucity of knowledge exists regarding the differences between meningiomas arising from these two anatomic compartments in terms of histopathologic subtypes, molecular tumor biology, surgical principles, long-term functional outcomes, and recurrence rates. To date, advancements at the bench have largely been made for intracranial meningiomas, including the discovery of novel gene targets, DNA methylation profiles, integrated diagnoses, and alternative systemic therapies, with few exceptions reserved for spinal pathology. Likewise, evolving clinical research offers significant updates to our understanding of guiding surgical principles, intraoperative technology, and perioperative patient management for intracranial meningiomas. Nonetheless, spinal meningiomas are predominantly relegated to studies considering non-specific intradural extramedullary spinal tumors of all histopathologic types. The aim of this review is to comprehensively report updates in both basic science and clinical research regarding intraspinal meningiomas and to provide illustrative case examples thereof, thereby lending a better understanding of this heterogenous class of central nervous system tumors.

Unraveling the Enigma: A Report of a Rare Case of Acute Cord Syndrome Caused by Spinal Meningioma

Spinal meningiomas (SMs) are a prevalent subtype of central nervous system tumors, with the majority adhering to the dura mater. In this case, we present the case of a 72-year-old female who initially reported numbness in her legs and the gradual onset of gait disturbances. Over a three-week period, these symptoms progressively worsened until she experienced a sudden onset of weakness and neurological deficits, leading to the diagnosis of acute cord syndrome (ACS). Magnetic resonance imaging revealed an anomaly within the extramedullary space, precisely located at the T8-T9 level. This anomaly exhibited peripheral gadolinium enhancement and demonstrated a dural tail sign, indicating the presence of an abnormal mass. Furthermore, a dorsal spine CT scan confirmed these findings by revealing a hyperdense lesion localized within the T8-T9 region. The lesion was situated posterior to the spinal cord, and conspicuous alterations in the coloration of the dura mater at the corresponding level were evident. A complete surgical resection was performed successfully, and the patient's surgical intervention proceeded without complications. Following the surgery, we observed significant improvements in both sensory and motor functions compared to the patient's preoperative state.

Robot-assisted T12 pediculectomy and resection of a ventral thoracic meningioma

Spinal meningiomas represent 25%-45% of intradural spinal tumors and are commonly seen in the thoracic spine. Ventral midline spinal meningiomas in the thoracic spine are challenging lesions to resect given their location in relation to the spinal cord. Resection for symptomatic or growing lesions requires adequate bone removal to limit retraction of the spinal cord. Surgical adjuncts such as intraoperative navigation, robotics, and ultrasound can improve the efficiency of and safety for resection of these lesions. The authors present a case of a complete resection of a ventral thoracic meningioma using a T12 transpedicular approach with robot-assisted navigated pediculectomy and intraoperative ultrasonography.

Location-specific technical nuances of spinal meningioma resection: an operative video case series

The objective of this video was to demonstrate technical nuances of intradural spinal meningioma (ISM) resection through a high-quality surgical video. The authors describe 3 patients with ISM in the cervicomedullary, cervical, and thoracic regions. Patients underwent surgery in the prone position with laminectomy, dorsal durotomy, and then resection of the mass. Case 1 required a suboccipital craniectomy and dissection of the tumor away from the vertebral artery. In case 2, special emphasis is placed on sectioning the dentate ligament with cord rotation. Case 3 highlights meticulous circumferential arachnoid release and the use of ultrasound. Patients saw significant neurological improvement postoperatively. This video provides clear instruction on location-specific technical nuances of ISM removal.