Recapping T-saw laminocostotransversoplasty for ventral meningiomas in the thoracic region.

摘要

BACKGROUND: Treatment of ventral lesions to the spinal cord in the thoracic spinal canal (e.g., meningiomas) are surgical challenges. Original or modified costotransversectomy has been commonly used for extirpation of such lesions. However, these techniques incur great loss of posterior elements followed by spinal instability that requires spinal fusion. The authors have developed a new surgical technique that combined the advantages of posterolateral exposures and recapping laminoplasty (recapping T-saw laminocostotransversoplasty). The purpose of this study was to examine the safety and effectiveness of this technique for surgical excision of ventrally located meningiomas in the thoracic region. METHODS: Three patients underwent recapping laminocostotransversoplasty for extirpation of ventral meningiomas in the thoracic spine. A T-saw was used for bone cutting. Following tumor extirpation with the infiltrated dura and dural reconstruction, the resected posterior elements were recapped to their original sites. Patients were evaluated both clinically and radiographically by plain radiography and computed tomography (CT). RESULTS: Tumor excision, dural reconstruction, and bone recapping were achieved without neurological complications in all patients. Neurological improvement was observed dramatically in all three patients. A mean of 2.3 laminae and 1.3 ribs were excised. The mean follow-up was 9.7 years. CT scans confirmed primary bony union in all patients within 6 months. No major complications were reported. CONCLUSIONS: Recapping T-saw laminocostotransversoplasty not only provides greater access to the anterior thoracic spinal canal but also allows anatomical reconstruction of the excised bone.