Cervical Meningioma Research Articles

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.

Anterior approach to remove a pre-medullary meningioma in the cervical spine: Technical case report

BackgroundRegarding their relation to the spinal cord (SC), resection of pre-medullary meningiomas may be technically challenging. Anterior approach via corpectomy represents a nice option reducing the need for mobilization of the SC. Case descriptionWe describe the case of a patient presenting with a cervical meningioma, located anterior to the SC and operated on through an anterior approach. Surgery consisted of a 2-levels discectomy and C7 corpectomy, midline opening of the dura and then microsurgical resection of the tumor. After coagulation of the implantation base, the dura was then closed in a watertight fashion. Finally, the anterior column was reconstructed using a titanium mesh-cage and anterior plating. ConclusionIn the case of cervical meningioma located anterior to the SC, anterior approach may be considered as an alternative option to remove the tumor.

Cervical meningioma with resultant bifid appearing spinal cord

Spinal meningiomas represent 1.2% to 12% of all central nervous system meningiomas, accounting for 25% to 46% of all intradural extramedullary lesions [1]. There is a female predominance and incidence is higher in Caucasians and Asian Pacific Islanders [1,2]. A recent systematic review on spinal meningiomas revealed thoracic (64.6%) and cervical (22.7%) to be the most common levels involved [5]. Recurrence is related to extent of resection and WHO grade. Recurrence rates have been documented between 1.3% and 13%, in a study on 173 cases a recurrence rate of 2.3% was reported [3].

Cervical meningioma resection including the inner dura through an open-door laminoplasty using hydroxyapatite spacers: A case report

Background: The ideal surgery for spinal cord tumors is complete resection to prevent recurrence. However, it should be accomplished safely/effectively without risking increased morbidity. Here, we report a cervical meningioma that was totally resected, including the inner dura, through a laminoplasty performed with hydroxyapatite (HA) spacers.Case Description: A 61-year-old Asian male presented with a symptomatic intradural extramedullary C4-C6 cervical meningioma. At surgery, this required resection of the inner dural layer through an open-door laminoplasty. Preservation of the outer dural layer facilitated a watertight closure and the avoidance of a postoperative cerebrospinal fluid (CSF) fistula. Notably, the laminoplasty utilized HA spacers which were magnetic resonance (MR) compatible allowing for future follow-up studies to evaluate for tumor recurrence. At 5-year follow-up, the tumor had not recurred, the patient was asymptomatic, and alignment was maintained.Conclusion: Gross total resection of an intradural extramedullary C4-C6 cervical meningioma was performed with removal of just the inner dural layer. Preservation of the outer dural layer allowed for a watertight closure and the avoidance of a postoperative CSF leak. Further, laminoplasty using HA spacers allowed for successful tumor resection, adequate fusion/stabilization, while not interfering with future MR studies (e.g., HA MR compatible).

Microsurgical Management of Ventral Intradural-Extramedullary Cervical Meningiomas: Technical Considerations and Outcomes

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. 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. 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. 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.

Commentary: Surgical Resection of Cervical Meningioma: 3-Dimensional Operative Video.

Commentary: Surgical Resection of Cervical Meningioma: 3-Dimensional Operative Video.

High cervical meningioma: a patient case report and literature review

Cervical spine meningiomas are uncommon. They present with motor, sensory and other nonspecific symptoms like pain. We present a first case at our hospital. A 33yr old female presented with 5months history of spastic quadriparesis, gait ataxia and pain and forceful contractions of the left upper limb. She had been seen in different health centres and diagnosed as conversion disorder. Brain CT was normal, C-spine CT showed a 2*3cm homogenous lesion at C2-C3.Simpsons 2 resection was done with no complications. Post-operative physical rehabilitation with physiotherapy was instituted with good recovery. By 6 weeks' post-operative, she was ambulating without support.

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.

Spontaneous C1 Anterior Arch Fracture Following C1 Laminectomy for Cervical Meningioma: A Case Report and Review of Literature

Background: A spontaneous C1 anterior arch fracture is a sparsely reported event following a C1 laminectomy done due to various etiologies. Case report: An 82-year-old patient who presented with severe neck pain and instability two years following a C1-C3 laminectomy for the excision of a cervical spinal cord meningioma. Revision of imaging revealed a C1 anterior arch fracture evident already on early post-op MRI. Conclusion: Spontaneous C1 anterior arch fracture following C1-Laminctomy without fusion may be more prevalent than once thought and many cases may go by undiagnosed. Surgeons should take this complication into account when offering and planning such surgery and during post-op followup. Further studies are required in order to establish the exact frequency and to clearly identify the risk factors for the occurrence of post laminectomy anterior arch fractures.

The Four Fixation Points of the Axis: Technique and Case Report.

Instrumentation of the axis can be accomplished through a variety of techniques including transarticular screw fixation, pars and pedicle screw fixation, translaminar screw fixation, and posterior wiring. We report on the evolution of the axial 4-screw technique. Retrospective case review. After exposure of posterior spinal elements, the medial and superior walls of the C2 pedicle were identified from within the spinal canal. A high-speed drill was then advanced under lateral fluoroscopy, which guided craniocaudal angulation. Medial angulation was based on anatomic landmarks and preoperative imaging. This was followed by placement of translaminar screws according to the technique described by Wright. When extending the construct into the subaxial spine or the occiput, lateral connectors are placed in translaminar screws, which are usually more offset. The rod is directly connected to the pedicle screws, which are usually more in alignment with the subaxial/occipital instrumentation. Two male patients ages 56 and 58 underwent posterior instrumentation of the axis employing a combination of pedicle and laminar polyaxial screws. Indications included multilevel spinal cord compression and deformity in a patient with Down syndrome and cervical meningioma, respectively. Follow-up was 1 year and 5 years, respectively. Medical complications (N = 2) occurred in the patient with Down syndrome resulting in prolonged intubation with tracheostomy placement. Reduction was maintained in both patients at last follow-up. There were no neurologic, vascular, or instrumentation related complications. The axis serves as a versatile anchor point and offers 4 potential points of fixation. Lateral connectors play a crucial role and allow for incorporation of the C2 screws with the rest of the construct. Local anatomy will dictate the necessity and ability to place instrumentation and detailed preoperative planning is of paramount importance.

Lateral Approach for Anterior and Anterolateral Placed Cervical Meningioma or Schwannoma

Introduction Cervical meningioma and schwannoma are benign tumors that may present with a wide variety of clinical features. Surgical treatment of those tumors carries a risk of neurological complications and spinal deformities. Surgical approaches include posterior, anterior, or anterolateral options. This is a Descriptive retrospective clinical case series to evaluate the lateral surgical approach in these tumors. Patients and Methods We reviewed patients who underwent lateral surgery for anterior and anterolateral placed cervical meningioma or schwannoma through the past 7 years. A total of 23 patients including 15 females and 8 males were reported. Mean age was 46 years. The average duration of history was 14.9 months. Fourteen patients had meningioma and 9 had schwannoma. According to the JOA-score 15 were normal, 5 were grade-1 and 3 was grade-2. The following factors were evaluated; age, sex, duration, pathology, levels, topographical locations, neurological status, operative time, blood loss, hospital stay, morbidity, and clinical outcome. Results All patients were operated through the lateral cervical approach. All patients but three had total tumor removal where small fragment were lift due to technical reasons. According to the JOA-score the 15 normal patients remain the same, the 5 grade-1 improved to normal, and the 3 grade-2 patients improved to normal in one and to grade-1 in another. There was no reported major morbidity or mortality. CSF leak into the closed drainage system was reported in 5 patients without serious effects. Conclusions The lateral approach allows for safe and effective removal of anterior and anterolateral placed cervical meningioma or schwannoma. It gives a direct access to tumor without risk of cord manipulation or destabilizing the spine. In addition it gives the same clinical results.as the standard posterior approach.

A Rare Case of Cervical Dumbbell Meningioma with the C2 Spinous Process Preservation

Dumbbell growth is often observed in schwannoma but rarely in meningioma. In particular, the occurrence of dumbbell meningioma at the cervical cord level in Japan is markedly rare. We reported an elderly case with symptomatic meningioma that developed in a dumbbell shape from cervical spine and was treated successfully by surgery.

Surgical management of ventrally based lower cervical (subaxial) meningiomas through the lateral approach: Report on 16 cases

ObjectivesSpinal meningiomas are benign and relatively rare tumors. These tumors present about only 25% of primary spinal tumors. Although spinal meningiomas are considered as slowly growing benign tumors, yet they may cause devastating neurological deficits rendering patients crippled. This study describes performing a posterolateral approach to surgically treat anterior based cervical meningioma. We hereby report on 16 cases operated upon using this approach, and we present our results and display some of our cases with special emphasis on achieving total resection, rate of recurrence and the neurological outcome. Patients and methodsThe study reports on 16 patients who underwent surgery for anterior based cervical meningioma. Data regarding age, sex, duration and type of symptoms, levels, topographical locations, surgical results, and histological features are presented. ResultsThe age ranged between 19 and 78 years old with a mean age of 48.3 years. The initial symptom among most patients (13 patients) was neck pain, numbness and radicular pain were found in 9, and clumsiness of the upper extremity in 7 patients. Total excision with dural coagulation was done in 11 cases, and spilt dura technique was feasible in 4 cases where the tumor together with the inner dura layer was resected. We encountered one case of atypical meningioma with Pia and arachnoid invasion which rendered total excision too risky and only subtotal resection was achieved. There were no major surgical or permanent neurological complications. Lateral mass fixation was used in 2 patients with a strictly midline anterior tumor in which a total facetectomy was done. All patients were followed up for an average of 3.6 years. Tumor recurrence was seen in 3 patients. ConclusionsThe lateral approach allows for safe and total removal of ventral cervical meningioma. This approach gives a direct avenue to the tumor without risk of destabilizing the vertebral column. The rate of recurrence is the same when using the anterior approach but is less invasive with less blood loss.

Imaging of Cervical Extradural En-Plaque Meningioma

Meningioma is one of the most common spinal extramedullary tumors, largely intradural. An extradural localization is possible but less frequent. There are two morphologically different types of meningioma: one is round, and the other is the "en-plaque" form, that grows along the dura mater like a sheet. The "en-plaque" form, is unusual. We report on an unusual case of epidural and extraspinal "en-plaque" meningioma, describing the MRI and CT features and discussing the possible principal differential diagnosis (neurolymphomatosis, plexiform neurofibromas/schwannomas and metastasis).

Meningioma espinal. Un hallazgo no esperado

Spinal tumors are rare in the group of all central nervous system (CNS). Among them, meningiomas are one of the most common (25-46% of spinal tumors). Meningioma originate from the meningothelial cells. They are generally benign, slow-growing, and predominate in middle age or elderly women. They are especially located in the thoracic spine. They have no specific symptoms although they usually present with pain, muscle weakness, sensory disturbances and urinary incontinence. This lack of specific symptoms causes late diagnosis and they are usually masked by other more common diseases as herniated disk or degenerative spinal disease. If an early diagnosed is carried out, treatment outcomes are excellent. We present a case of cervical meningioma found by chance thanks to a MRI requested due to suspicion of another disease.

Meningioma intramedular cervical: relato de caso e revisão da literatura

ResumoOs meningiomas estão entre os tumores benignos mais comuns do canal espinhal, em adultos, encontrados, predominantemente, nos segmentos torácicos. Segundo a literatura, a ocorrência de um meningioma intramedular cervical é muito rara, com apenas oito trabalhos científicos relatados até o momento. Apresentaremos o nono relato de caso – talvez o primeiro relato publicado na literatura médica brasileira – e revisaremos os estudos anteriores. Paciente, de 40 anos de idade, iniciou com sintomas de fraqueza na mão direita e dores cervicais que se agravavam durante a noite. A ressonância magnética revelou lesão intramedular extensa cervical. A paciente foi submetida somente à biópsia, por causa de dificuldades na ressecção, sendo depois proposta radioterapia. O tumor teve uma discreta redução, a paciente permaneceu sem piora dos sinais e sintomas durante os oito anos de evolução. Embora muito raros, meningiomas intramedulares cervicais existem e devem estar no diagnóstico diferencial de tumores nessa localização. O principal tratamento dessas lesões, de acordo com relatos anteriores, é a cirurgia, com bons resultados.

Canine meningioma: A case report of a rare subtype and novel atlanto basioccipital surgical approach

To describe a novel histological subtype of skull base and cranial cervical meningioma operated upon through an uncommon atlanto basioccipital approach. Clinical case report. A seven-year-old neutered female Boxer. The dog was presented due to lethargic behavior, signs of head and neck pain, and ongoing tetraparesis. Neurological examination and magnetic resonance imaging led to diagnosis of a ventral spinal canal mass causing severe cord and brainstem compression and which required surgical management. The mass was approached through a ventral craniectomy extending cranially on the basioccipital bone. Extemporaneous cytological examination of the mass led to confirmation of neoplastic nature of the abnormal tissue. Cytoreduction of the mass was performed using multiple cycles of curettage, lavage and suction. Histopathological examination of the tumour was consistent with a papillary variant of meningioma. Adjuvant therapy was declined by the owners. The dog improved considerably in the postoperative period, however three months after surgery signs of recurrence led to euthanasia. Basioccipital craniectomy allowed a limited but sufficient approach for cytoreduction of a compressive meningioma of the brainstem and cranial cervical spinal cord. Papillary meningiomas are locally infiltrative and postoperative recurrence is common. Basioccipital approach combined with cranial atlanto corpectomy can be performed to relieve compression of the caudal brainstem and cranial cervical cord.

A case of cervical spine meningioma following etanercept use in a patient with RA

A 70-year-old female with active rheumatoid arthritis (RA) was administered etanercept to treat active disease that persisted despite therapy with conventional DMARDs. After 18 months of etanercept therapy, her RA symptoms had improved; however, she developed quadriparesis. She presented to a specialist rheumatology clinic with weakness and numbness in her arms and legs; she also had difficulty in standing up and walking. Physical examination, neurological examination, nerve conduction studies, measurement of serum inflammatory markers and autoantibodies, MRI of the cranium and cervical spine, and X-rays of the chest and hands. The patient underwent neurosurgery to resect a 1 x 2 cm mass in the cervical spine at C6-C7. Histopathologic examination of the excised mass revealed it to be a meningioma. Etanercept was discontinued because of a possible association between the drug and development of meningioma; however, shortly afterwards the patient experienced a flare of RA symptoms. High-dose NSAIDs and prednisolone were administered, but the patient died because of gastric perforation. To our knowledge, this is the first report in the literature of meningioma developing following use of tumor necrosis factor inhibitor therapy, and the first to suggest a cause-effect relationship.

Cervical Meningioma in Childhood

We report on a meningioma of the cervical spine in a 12-year-old boy with atypical clinical presentation. Meningiomas are relatively rare neoplasms in childhood, representing only 1 to 2% of all pediatric intracranial tumors. The distinction between the meningioma and another extramedullary, intradural tumors like schwannoma might pose difficulties. This case report points out that although a very rare tumor in children, it must be taken into account in differential diagnostics.

Two Cases of Cervical Meningioma Resected by Hemilaminectomy

Two Cases of Cervical Meningioma Resected by Hemilaminectomy