Lateral cervical approach for ventrally located upper cervical meningioma: experience of 14 cases with a narrative comparison with other surgical techniques.

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.

Embolization of a vertebral artery encased in a regrowth cervical meningioma before resection.

Background: Managing intraoperative bleeding may be challenging when a cervical tumor encases the vertebral artery (VA). Here, a patient with a recurrent cervical meningioma between the C1/2 and C3/4 levels and encasement of the right VA injury developed intraoperative bleeding that was endovascularly embolized postoperatively. Case Description: A 30-year-old female presented with a progressive quadriparesis, most markedly involving the right upper extremity. Six years ago, she had a cervical meningioma resected at the C2/3 level. The new MR revealed regrowth of intraspinal tumor between the C1/2 to C4/5 levels accompanied by extradural encasement of the right VA within the C2/3 and C3/4 foramina. Before the first surgery, the right VA was embolized (i.e., after a balloon occlusion test proved negative). During the attempted resection of the intradural/extradural tumor, bleeding from the right VA was encountered; it was temporarily controlled. After complete occlusion of the right VA was angiographically confirmed, a second-stage procedure to fully resect the extradural remanent of the tumor was undertaken. Conclusion: Endovascular embolization of the right VA before the attempted resection of a recurrent intraspinal/extraspinal cervical meningioma failed to occlude the vessel entirely. The VA bleeding encountered intraoperatively was temporarily controlled. Delayed total VA occlusion was angiographically observed before full tumor resection could be completed.

Cervical Spine Inhomogeneously Enhancing Lesion: Avoiding Confirmation Bias.

Confirmation bias is the tendency to seek information and evidence in order to confirm a preexisting hypothesis while giving less importance and overlook an alternative solution. This report describes the case of a 52-year-old man with a long history of neck pain and bilateral upper limbs paresthesias with a cervical intracanal inhomogeneously enhancing lesion. Despite all the preoperative radiological findings, a spinal meningioma an anterior approach was performed. The mass ended up being a large migrated hernia with the involvement of two levels. Before suggesting treatment, especially surgery, physicians and practitioners need to evaluate all of the possible alternatives in order to optimize patient outcome.

Minimally Invasive Resection of a Cervical Anterolateral Meningioma: 2-Dimensional Operative Video.

Intradural extramedullary spinal tumors were historically managed through traditional midline approaches. Although conventional laminectomy or laminoplasty provides a wide tumor and spinal cord exposure, they may cause prolonged postoperative neck pain and late kyphosis deformity. Minimally invasive ipsilateral hemilaminectomy preserves midline structures, reduces the paraspinal muscle disruption, and could avoid postoperative kyphosis deformity. A safe tumor resection through this approach could be complicated in large sized or anteromedullary located lesions. We present a surgical video of C3 antero located meningioma removed en bloc through a minimally invasive approach. The patient signed a written consent to publish video, recording, photograph, image, illustration, and/or information about him.

Spinal cord herniation following cervical meningioma excision: a rare clinical entity and review of literature.

BACKGROUND: Spinal cord herniation following surgery is an extremely uncommon clinical condition with very few reports in published literature. This condition usually occurs as a spontaneous idiopathic phenomenon often in the thoracic spine or following a scenario of post traumatic spinal cord/nerve root injury. Rarely has it been reported following spinal cord tumor surgery. PURPOSE: To document a case of cervical spinal cord herniation as a late onset complication following spinal cord tumor surgery with an atypical presentation of monoparesis. DESIGN: Case report. METHODS: We describe the clinical presentation, operative procedure, post operative outcome and review of literature of this rare clinical condition. RESULTS: A 57-year-old man presented with right upper limb monoparesis due to a spinal cord herniation 6 years after a cervical intradural meningioma excision. The patients underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms. CONCLUSIONS: Spinal cord herniation must be considered as differential diagnosis in scenarios of spinal cord tumor excision presenting with late onset neurological deficit. These cases may present as paraparesis, Brown-sequard syndrome and rarely as in our case as monoparesis.