Surgical results of the resection of spinal meningioma with the inner layer of dura more than 10 years after surgery

Abstract

Most spinal meningiomas arise from the thoracic dura in middle-aged and elderly women. Simpson grade 1 resection is recommended to avoid recurrence. For ventral and ventrolateral tumors, reconstruction after total dural resection is difficult, and spinal fluid leakage is likely. To overcome this concern, Saito et al. developed the technique of resecting the tumor with the inner dural layer, preserving the outer dural layer. Although meningioma rarely recurs, the recurrence period is approximately 8 years postoperatively. No studies have evaluated long-term (> 10-year) outcomes of the Saito method. Here, we report 10 cases of the Saito method with > 10-year follow-up and compare outcomes with those of other standard approaches. Twenty-nine pathology-confirmed meningioma patients underwent surgery in our department, ten with the Saito method. We investigated resection method (dura mater treatment), pathological type, and recurrence and compared pre- and postoperative clinical findings. The median follow-up was 132 months. Recurrence occurred after Simpson grades 3 and 4 resection. Simpson grades 1, 2, and the Saito method resulted in no recurrence. Neurological symptoms improved in all patients at final follow-up. This is the first report of long-term outcomes of the Saito method. The method achieved good neurological improvement with no recurrence in > 10-year follow-up.

Current Knowledge on Spinal Meningiomas—Surgical Treatment, Complications, and Outcomes: A Systematic Review and Meta-Analysis (Part 2)

“…Approximately 95% of the studies had follow-up times beyond the two-year mark, while only 40% extended beyond five years. Only five studies had a follow-up time longer than ten years [ 5 , 8 , 9 , 11 , 33 ]. A positive correlation was identified between recurrence rates and length of follow-up (Pearson correlation coefficient: R = 0.36, p = 0.021, Supplementary File S3, Figure S1 ).…”

“…Only three studies reported on the dura preservation method (Saito method) [ 5 , 33 , 34 ], which precluded a meta-analysis of data. However, pooling of the data revealed comparable recurrence rates for the dura preservation method and Simpson grade 2 resection, where the dural attachments are left but coagulated (8.3% vs. 10%).…”

“…It is well-established that surgery is the preferred treatment of choice for spinal meningiomas [ 1 ], as tumor removal usually relieves symptoms with little risk for complications or recurrence and a high frequency of postoperative improvement [ 2 , 3 , 4 ]. Cerebrospinal fluid leak, transitory or permanent neurological impairments, and infections are the most commonly reported complications, while pulmonary embolisms were behind most of the fatalities [ 2 , 3 , 5 , 6 , 7 ]. The Simpson grading scheme is the one most commonly used in meningioma surgery to describe the extent of tumor resection and to estimate the likelihood of tumor recurrence.…”

Age at Diagnosis and Baseline Myelomalacia Sign Predict Functional Outcome After Spinal Meningioma Surgery

“…Recently, a new technique was presented by Saito et al (46) which leaves the outer layer of the dura intact and the tumor attachment is resected along with the inner dural layer. This method was predominantly introduced and used for tumors with a ventral dural attachment in order to reduce the rate of CSF fistulas and the authors observed also no recurrence in a retrospective series of 10 patients with a follow-up of 10 years (47). Therefore, this seems to be an alternative approach to Simpson grade I resection with regard to long term tumor control and avoidance of CSF fistulas.…”

Current knowledge on spinal meningiomas: a systematic review protocol

“…Aggressive removal of the dura may reduce the risk of recurrence but increases the risk of spinal cord injury and postoperative leakage of cerebrospinal fluid. Surgical techniques with removal of the inner dural layer, may constitute an intermediate solution 24 25. The most commonly reported postoperative complications are wound infections, cerebrospinal fluid leaks, kyphosis, venous thromboembolisms and transient or permanent neurologic deficits 4 7 26–28.…”