Anterior Approach for Removal of a Cervical Intradural Tumor

Abstract

A case of an intradural extramedullary meningioma of the cervical spine excised through an anterior approach is reported. This permitted a complete excision without manipulation of the cord followed by a rapid and complete recovery. The technique of excision and bone grafting is described.

Complication Avoidance in the Resection of Spinal Meningiomas

“…Anterior cervical approaches provide for more direct access to visualize the anterior intradural pathology, control the lesion vascular supply, and minimize cord manipulation during resection (2,16,27,54). The anterior cervical approach with corpectomy has been used for ventral intradural midline cervical spinal meningiomas with good results and limited neurologic spinal cord morbidity (1,2).…”

“…This approach is not facile, often requiring vertebral body resection, multilevel reconstruction, and the attendant morbidity of such access. Nevertheless, it may potentiate more complete resection and safer tumor manipulation with less neurologic morbidity (10,13,16,20).…”

Spinal Meningiomas: A Review

“…The anterior cervical approach has also been used with success in resecting ventral cervical meningiomas [27,[29][30][31][32]. Advantages of an anterior approach to ventral cervical meningiomas include a large bony window for surgical exposure with direct visualization of the intradural pathology ventral to the spinal cord, extradural coagulation of anterior tumor feeders, and lack of necessity for cervical cord manipulation and retraction [27].…”

Surgical management of intradural extramedullary tumors located anteriorly to the spinal cord

“…[3][4][5][6][7][8][9][10] Some of these lesions can be located anteriorly to the spinal cord, constituting a challenge for spine surgeons, as the standard surgical exposure is usually performed by posterior midline approaches using a laminectomy or a laminoplasty. To overcome that difficulty, anterior 11,12 and combined approaches have been described in the literature, especially for thoracic spine schwannomas with intrathoracic extensions. 13 Jenny et al 14 have employed a transthoracic, transvertebral approach for successful removal of an anteriorly placed, calcified meningioma; Dickman and Apfelbaum 15 employed a similar anterior thoracoscopic approach for removal of a schwannoma, while O'Toole and McCormick 16 reported a complete resection of a ventral schwannoma via an anterior cervical corpectomy with reconstruction.…”