title: Posterolateral approach for spinal intradural meningioma with ventral attachment.
abstract: BACKGROUND
  Spinal meningioma with ventral attachment is a challenging pathology. Several technical modifications have been proposed to secure safe and precise resection of these tumors.
  
  
  METHODS
  This retrospective study focused on the precise and safe surgery of spinal meningiomas with strictly ventral attachment of cervical or thoracic spine. The surgical technique included a lateral oblique position for the patient, laminectomy with unilateral medial facetectomy on the tumor side, and spinal cord rotation with the dentate ligament. The neurological status of patients was assessed using the modified McCormick functional schema (mMFS) and sensory pain scale (SPS) before and at least 3 months after surgery. Patients were followed-up for a mean of 23.7 months. Tumor removal was graded using the Simpson grade for removal of meningiomas, and the extent of excision was confirmed using early postoperative magnetic resonance imaging.
  
  
  RESULTS
  Simpson grade 1 or 2 resections were achieved in all cases. No major surgery-related complications were encountered, postoperatively. The mean mMFS score before surgery was 3.1, improving significantly to 1.7 after surgery (P < 0.05). The mean SPS score before surgery was 2.4, improving significantly to 1.6 after surgery (P < 0.05).
  
  
  CONCLUSIONS
  This surgical technique offers a posterolateral surgical corridor to the ventral canal of both cervical and thoracic spine. The present preliminary analysis suggests that functional outcomes were satisfactory with minimal surgery-related complications, although considerable surgical experience is needed to achieve a high level of surgical confidence.
authors.affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Takami
authors.affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Naito
authors.affiliation: Department of Neurosurgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Yamagata
authors.affiliation: Department of Neurosurgery, Yao Tokushukai General Hospital, Osaka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Arima
authors.affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohata
keywords: Extramedullary; meningioma; posterolateral approach; spinal cord tumor; ventral