title: Spinal Cervical Meningiomas: The Challenge Posed by Ventral Location.
abstract: OBJECTIVE
  To evaluate the incidence, clinical presentation, operative techniques, and long-term outcome of spinal cervical meningiomas after surgery.
  
  
  METHODS
  Twenty-two patients harboring spinal meningiomas on cervical region were treated between 2004 and 2014 in our department. Diagnosis was made via magnetic resonance imaging and confirmed histologically. Microsurgical resection was performed through different surgical approaches according to location of the tumor. To remove the tumor, the posterior, far-lateral, and combined approaches were used, respectively, in 13 patients (56%), 8 patients (35%), and 2 patients (9%).
  
  
  RESULTS
  The mean follow-up was 40 ± 26.5 months. The most common site of dural attachment of meningioma was ventral or ventrolateral to the spinal cord. Macroscopic resection was considered complete in 55% of cases. Neurologic improvement was observed in 60% of cases. The rate of operative mortality and morbidity was high (26.5%). Five patients underwent postoperative radiotherapy according to the actual recommendation, and the overall recurrence rate was 9%.
  
  
  CONCLUSIONS
  Spinal meningiomas are benign tumors for which advances in imaging tools and microsurgical techniques have yielded better results. The goal of surgery should be the total resection, which significantly decreases the risk of recurrence with an acceptable morbidity. Cervical locations represent a challenge particularly for ventro and ventrolaterally located tumors. Despite the difficulty of performing a complete resection, the results obtained in this work advocate for the use of the far-lateral approach to manage meningiomas locate anterior to the neural axis.
authors: Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier, France; National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom. Electronic address: nlonjon@gmail.com.
authors: Nicolas
authors: N
authors: Lonjon
authors: National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors: Vittorio
authors: V
authors: Russo
authors: National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors: Manlio
authors: M
authors: Barbarisi
authors: National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors: David
authors: D
authors: Choi
authors: National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors: James
authors: J
authors: Allibone
authors: National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors: Adrian
authors: A
authors: Casey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cervical; Meningioma; Outcome; Surgical approach; Tumor