1
|
Ayyad A, Alhoobi M, Kockro R, Shaaban A, Kessel G, Kanaan T, Dumour E, Hammadi F, Abu Jarir R, Al-Salihi MM. Lateral cervical approach for ventrally located upper cervical meningioma: experience of 14 cases with a narrative comparison with other surgical techniques. Int J Neurosci 2024; 134:292-300. [PMID: 35815394 DOI: 10.1080/00207454.2022.2100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Upper cervical meningioma represents a large portion of intradural extramedullary tumors that occur in the cervical spinal canal. Most of them are located ventrally or ventrolateral to the spinal cord. Reaching lesions at this location surgically is technically challenging. OBJECTIVES The ideal approach to ventrally located upper cervical lesions continues to be controversial. The aim of this study was to discuss the advantage of the lateral cervical approach and compare it with other surgical routes. METHODS This retrospective study was conducted on all cases of ventrally located upper cervical meningiomas (C1-C3) who have been operated on using the lateral cervical approach in a tertiary neurosurgery unit between 2006 and 2020. Demographic, clinical, surgical, and follow-up data were collected from hospital records. RESULTS During the study period, fourteen patients (Nine females and five males, aged 42-73 years) were recruited. The follow-up period was 2-16 years. The most frequent presenting symptoms were neck pain, occipital headache, motor deficits, and sensory disturbances. Total excision was achieved in all patients. All patients who had preoperative motor deficits improved significantly postoperatively, and those who presented with sensory disturbance had partial recovery. There was neither mortality nor permanent neurological morbidity. CONCLUSION A lateral cervical approach is a safe approach for ventrally located upper cervical lesions. In our series, it offered enough exposure for a safe dissection and total or extensive subtotal removal of the tumors. Retraction or rotation of the neuroaxis was avoided, and the incidence of complications (injury of neural or vascular structures, instability, infection) was very low.
Collapse
Affiliation(s)
- Ali Ayyad
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
- Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
| | - Mohammed Alhoobi
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | - Ralf Kockro
- Department of Neurosurgery, Hirslanden Klinik, Zurich, Switzerland
| | - Ahmed Shaaban
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | - Gerd Kessel
- Neurosurgery, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Tareq Kanaan
- Department of Neurosurgery, Jordan University Hospital, Amman, Jordan
| | - Elias Dumour
- Department of Pediatric Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK
| | - Firas Hammadi
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | - Raed Abu Jarir
- Department of Neurosurgery, Hamad Medical Corporation, Doha, Qatar
| | | |
Collapse
|
2
|
Guvenc Y, Topal B, Verimli U, Biyikli E, Akdeniz E, Ziyal İ. Posterolateral Paramass Approach to Lesions Located at the Anterior C1-2 Level: A Cadaver Study. World Neurosurg 2024; 186:e566-e576. [PMID: 38583564 DOI: 10.1016/j.wneu.2024.03.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE A novel posteriolateral surgical approach is described that will provide safe access to intradural and extradural lesions located in the anterior part of the spinal cord (SC) at the C1-2 level and to the odontoid in single session. METHODS A total of five cadavers and two dry C1 vertebrae were used in this study. The study involved obtaining computed tomography magnetic resonance imaging scans and magnetic resonance imaging of all cadaver groups before and after the procedures. Group 1: Control; Group 2: Unilateral C1 posterior arch was removed, the inferomedial part of C1 lateral mass was removed, and access the anterior and lateral aspects of the SC. Group 3: In addition, odontoid was removed, Group 4: In addition, unilateral C1- C2 screw was placed. Group 5: In addition, bilateral C1-C2 screw was placed. RESULTS The median distance from the midpoint of C1 posterior tubercle to vertebral groove which was removed in groups is 21.4 ± 2.88 mm. The average width of C1 lateral mass was 13.4±2.4 mm. After the lateral mass was drilled, its width decreased to 10,2 mm.This area was sufficient to open a surgical corridor and reach the anterior of SC and odontoid. After the procedure, no instability was found in group 2 without instrumentation on computed tomography and magnetic resonance imaging scans. CONCLUSIONS It is possible to access the anterior C1-C2 via a posterolateral paramass approach by drilling 20%-30% of the lateral mass, providing an open pathway for easy intervention in C1-C2 intradural lesions. It is also possible to perform odontoid resection using this approach.
Collapse
Affiliation(s)
- Yahya Guvenc
- Department of Neurosurgery, School of Medicine, Marmara University, Istanbul, Turkey; Neurological Sciences Institute, Marmara University, Istanbul, Turkey; Department of Neurological Sciences, Institute of Health Sciences, Marmara University, Istanbul, Turkey.
| | - Bahadır Topal
- Department of Neurosurgery, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ural Verimli
- Department of Anatomy, School of Medicine, Marmara University, Istanbul, Turkey
| | - Erhan Biyikli
- Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Esra Akdeniz
- Department of Medical Education, Marmara University, Istanbul, Turkey
| | - İbrahim Ziyal
- Department of Neurosurgery, School of Medicine, Marmara University, Istanbul, Turkey
| |
Collapse
|
3
|
Haddad AF, Safaee MM, Pereira MP, Oh JY, Lau D, Tan LA, Clark AJ, Chou D, Mummaneni PV, Ames CP. Posterior-based resection of spinal meningiomas: an institutional experience of 141 patients with an average of 28 months of follow-up. J Neurosurg Spine 2023; 38:139-146. [PMID: 36152326 DOI: 10.3171/2022.7.spine211603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/06/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Spinal meningiomas pose unique challenges based on the location of their dural attachment. However, there is a paucity of literature investigating the role of dural attachment location on outcomes after posterior-based approach for spinal meningioma resection. The aim of this study was to investigate any differences in outcomes between dural attachment location subgroups in spinal meningioma patients who underwent posterior-based resection. METHODS This was a single-institution review of patients who underwent resection of a spinal meningioma from 1997 to 2017. Surgical, oncological, and neurological outcomes were compared between patients with varying dural attachments. Multivariate analysis was utilized. RESULTS A total of 141 patients were identified. The mean age was 62 years, and 110 women were included. The sites of dural attachments were as follows: 16 (11.3%) dorsal, 31 (22.0%) dorsolateral, 17 (12.1%) lateral, 40 (28.4%) ventral, and 37 (26.2%) ventrolateral. Most meningiomas were WHO grade I (92.2%) and in the thoracic spine (61.0%). All patients underwent a posterior approach for tumor resection. There were no differences between subgroups in terms of largest diameter of tumor resected (p = 0.201), gross-total resection (GTR) or subtotal resection (p = 0.362), Simpson grade of resection, perioperative complications (p = 0.116), long-term neurological deficit (p = 0.100), or postoperative radiation therapy (p = 0.971). Cervical spine location was associated with reduced incidence of GTR (OR 0.271, 95% CI 0.108-0.684, p = 0.006) on multivariate analysis. The overall incidence of recurrence/progression was 4.6%, with no difference (p = 0.800) between subgroups. Similarly, the average length of follow-up was 28.1 months, with no difference between subgroups (p = 0.413). CONCLUSIONS Posterior-based approaches for resection of spinal meningiomas are safe and effective, regardless of dural attachment location, with similar surgical, oncological, and neurological outcomes. Comparison of long-term recurrence rates between dural attachment subgroups is required.
Collapse
Affiliation(s)
- Alexander F Haddad
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael M Safaee
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Matheus P Pereira
- 2Medical Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina; and
| | - Jun Yeop Oh
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Darryl Lau
- 3Department of Neurosurgery, New York University, New York, New York
| | - Lee A Tan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Aaron J Clark
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Christopher P Ames
- 1Department of Neurological Surgery, University of California, San Francisco, California
| |
Collapse
|
4
|
Huang M, Tetreault TA, Vaishnav A, York PJ, Staub BN. The current state of navigation in robotic spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:86. [PMID: 33553379 PMCID: PMC7859750 DOI: 10.21037/atm-2020-ioi-07] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The advent and widespread adoption of pedicle screw instrumentation prompted the need for image guidance in spine surgery to improve accuracy and safety. Although the conventional method, fluoroscopy, is readily available and inexpensive, concerns regarding radiation exposure and the drive to provide better visual guidance spurred the development of computer-assisted navigation. Contemporaneously, a non-navigated robotic guidance platform was also introduced as a competing modality for pedicle screw placement. Although the robot could provide high precision trajectory guidance by restricting four of the six degrees of freedom (DOF), the lack of real-time depth control and high capital acquisition cost diminished its popularity, while computer-assisted navigation platforms became increasingly sophisticated and accepted. The recent integration of real-time 3D navigation with robotic platforms has resulted in a resurgence of interest in robotics in spine surgery with the recent introduction of numerous navigated robotic platforms. The currently available navigated robotic spine surgery platforms include the ROSA Spine Robot (Zimmer Biomet Robotics formerly Medtech SA, Montpellier, France), ExcelsiusGPS® (Globus Medical, Inc., Audubon, PA, USA), Mazor X spine robot (Medtronic Navigation Louisville, CO; Medtronic Spine, Memphis, TN; formerly Mazor Robotics, Caesarea, Israel) and TiRobot (TINAVI Medical Technologies, Beijing, China). Here we provide an overview of these navigated spine robotic platforms, existing applications, and potential future avenues of implementation.
Collapse
Affiliation(s)
- Meng Huang
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Tyler A Tetreault
- Department of Orthopedic Surgery, University of Colorado, Aurora, Colorado, USA
| | - Avani Vaishnav
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Philip J York
- Department of Orthopedic Surgery, University of Colorado, Aurora, Colorado, USA
| | | |
Collapse
|
5
|
Eroglu U, Bahadır B, Tomlinson SB, Ugur HC, Sayaci EY, Attar A, Caglar YS, Cohen Gadol AA. Microsurgical Management of Ventral Intradural-Extramedullary Cervical Meningiomas: Technical Considerations and Outcomes. World Neurosurg 2020; 135:e748-e753. [PMID: 31901496 DOI: 10.1016/j.wneu.2019.12.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Cervical meningiomas are uncommon intradural-extramedullary tumors that have a tendency to be situated anterior to the spinal cord. The optimal surgical corridor to reach purely ventral cervical meningiomas has not been established. This article presents a series of patients with ventral cervical meningiomas treated via 1 of 2 microneurosurgical approaches: the anterior approach with corpectomy and fusion or the posterolateral approach. METHODS Eight patients who underwent surgical resection of solitary, histopathologically confirmed, intradural-extramedullary cervical meningiomas of purely ventral location were retrospectively examined. Preoperative and postoperative Nurick scores quantified the degree of ambulatory function. Patients were followed for an average of 2.1 years after surgery. Postoperative imaging was performed to determine the extent of resection and to assess for tumor recurrence. RESULTS Two patients with lower cervical meningiomas underwent resection via an anterior approach with single-level corpectomy and fusion. Six patients were treated via a posterolateral approach including ipsilateral hemilaminectomy and partial facetectomy without fusion. No intraoperative or postoperative complications were observed. Gross total resection was achieved in 8 of 8 patients, although 1 patient exhibited tumor recurrence. Improvement in ambulatory function was observed in all patients. CONCLUSIONS Purely ventral cervical meningiomas are uncommon and pose unique technical challenges for neurosurgeons. We document favorable outcomes from 2 cases of lower cervical meningioma treated via an anterior approach and 6 cases of upper cervical tumors treated via a posterolateral approach. This series demonstrates operative considerations for effectively managing ventral cervical meningiomas.
Collapse
Affiliation(s)
- Umit Eroglu
- Department of Neurosurgery, School of Medicine, Ankara University, Yenimahalle, Ankara, Turkey
| | | | - Samuel B Tomlinson
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Hasan Caglar Ugur
- Department of Neurosurgery, School of Medicine, Ankara University, Yenimahalle, Ankara, Turkey
| | - Emre Yagiz Sayaci
- Department of Neurosurgery, School of Medicine, Ankara University, Yenimahalle, Ankara, Turkey
| | - Ayhan Attar
- Department of Neurosurgery, School of Medicine, Ankara University, Yenimahalle, Ankara, Turkey
| | - Yusuf Sukru Caglar
- Department of Neurosurgery, School of Medicine, Ankara University, Yenimahalle, Ankara, Turkey
| | | |
Collapse
|
6
|
A case report of an intramedullary cervical teratoma in an adult patient with cervical spondylotic radiculopathy. Neurocirugia (Astur) 2019; 30:238-242. [DOI: 10.1016/j.neucir.2018.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/31/2018] [Accepted: 09/25/2018] [Indexed: 12/27/2022]
|
7
|
Onken J, Obermüller K, Staub-Bartelt F, Meyer B, Vajkoczy P, Wostrack M. Surgical management of spinal meningiomas: focus on unilateral posterior approach and anterior localization. J Neurosurg Spine 2019; 30:308-313. [DOI: 10.3171/2018.8.spine18198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 08/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVESpinal meningiomas (sMNGs) are relatively rare in comparison to intracranial MNGs. sMNGs localized anterior to the denticulate ligament (aMNGs) represent a surgically challenging subgroup. A high perioperative complication rate due to the need for complex surgical approaches has been described. In the present study, the authors report on their surgical experience that involves two institutions in which 207 patients underwent surgery for sMNGs. Special focus was placed on patients with aMNGs that were treated via a unilateral posterior approach (ULPA).METHODSBetween 2005 and 2017, 207 patients underwent resection of sMNGs at one of two institutions. The following characteristics were assessed: tumor size and localization, surgical approach, duration of surgery, grade of resection, peri- and postoperative complication rates, and neurological outcome. Data were compared between the subgroups of patients according to the lesion’s relationship to the denticulate ligament and to surgical approach.RESULTSThe authors identified 48 patients with aMNGs, 86 patients with lateral MNGs, and 76 patients with posterior MNGs (pMNGs). Overall, 66.6% of aMNGs and 64% of pMNGs were reached via a ULPA. aMNGs that were approached via a ULPA showed reduced duration of surgery (131 vs 224 minutes, p < 0.0001) and had surgical complication rates and neurological outcomes comparable to those of lesions that were approached via a bilateral approach. No significant differences in complication rate, outcomes, and extent of resection were seen between aMNGs and pMNGs.CONCLUSIONSThe duration of surgery, extent of resection, and outcomes are comparable between aMNGs and pMNGs when removed via a ULPA. Thus, ULPA represents a safe route to achieve a gross-total resection, even in cases of aMNG.
Collapse
Affiliation(s)
- Julia Onken
- 1Department of Neurosurgery, Charité—Universitätsmedizin Berlin
- 2Berlin School of Integrative Oncology (BSIO), Berlin; and
| | - Kathrin Obermüller
- 3Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | | | - Bernhard Meyer
- 3Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Peter Vajkoczy
- 1Department of Neurosurgery, Charité—Universitätsmedizin Berlin
| | - Maria Wostrack
- 3Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| |
Collapse
|
8
|
Surgical management of ventrally located spinal meningiomas via posterior approach. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:181-186. [DOI: 10.1007/s00590-016-1860-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
|