Introduction: Meningiomas are the most common benign spinal tumor. Surgery is mostly curative however approximately 10% of benign spinal tumors recur1. Meningioma recurrence is associated with thecal invasion, degree of resection and histological characteristics of the tumor2. Resection of large ventral spinal tumors remains challenging due to greater risk of spinal cord injury and difficult proper tumor exposure. Surgical resection techniques include en-bloc resection of the tumor and involved dura; tumor resection with extensive coagulation of the dural bed; or dissection of the tumor and inner layer of the dura while sparing the outer layer for use in duraplasty6.
Methods: Patient is a neurologically intact seventeen year old female presenting with intradural extramedullary (IDEM) WHO Grade I recurrent ventral thoracic spinal meningioma at T10-T11 level with intraoperative evidence of nerve root invasion for which complete resection was performed. The resultant five centimeter circumferential dural defect necessitated three hundred and sixty degree spinal thoracic duraplasty.
Results: No postoperative cerebrospinal fluid leak or other complications related to the repair were encountered and patient returned to baseline neurological status postoperatively.
Conclusions: This is the first report of successful circumferential spinal dural repair using synthetic dural graft following resection of recurrent WHO Grade I spinal thoracic meningioma. Further follow-up will provide long term results of this procedure and further research on the application of this technique in dural repair during different surgeries at all spinal levels is warranted.
Patient Care: By introducing a new surgical technique we hope to guide future research to investigate the feasibility of applying such technique in practice to improve patient outcomes and quality of care
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe techniques for spinal meningioma resection 2) Discuss spinal dural repair methods 3) Identify circumferential duraplasty technique and approach
References: 1. Schick U, Marquardt G, Lorenz R: Recurrence of benign spinal neoplasms. Neurosurg Rev 24:20–25, 2001
2. Setzer M, Vatter H, Marquardt G, Seifert V, Vrionis FD: Management of spinal meningiomas: surgical results and a review of the literature. Neurosurg Focus 23:E14, 2007
3. King AT, Sharr MM, Gullan RW, Bartlett JR: Spinal meningiomas: a 20-year review. Br J Neurosurg 12:521–526, 1998