Background: The ventrally located intradural meningiomas in the thoracic spine are still considered
a challenge for all spine surgeons. Many surgical approaches were developed to excise
the lesion without violating the neural structures. They differ in their invasiveness,
safety, and efficacy. One of these approaches is the postero-lateral combined transpedicular-transarticular
approach (TPA-TAA). Patients and Methods: From January 2016 to December 2018, all patients with ventrally located thoracic
meningiomas were operated on using the combined TPA-TAA. We evaluated all the patients
preoperatively, immediate postoperative, and 6 months later. Clinical and functional
outcomes were assessed using the muscle strength grade and the Nurick grading system.
Magnetic resonance imaging was obtained for all patients postoperative and at 6 months
later. Results: After 6 months, all patients experienced clinical and functional improvement. The
mean muscle strength grade rose from 3.8 preoperatively to 4.8 after 6 months. According
to the Nurick grading system, the mean preoperative grade was 4.4 and dropped to 1.8
after 6 months. Minor transient complications such as superficial wound infection
and the cerebrospinal fluid leak were observed in 1 patient for each. Gross total
tumor excision was achieved in all patients. No cases of tumor recurrence were noted
during the follow-up period. Conclusions: This combined TPA-TAA is considered a safe and effective approach in excising ventrally
located intradural thoracic meningiomas with minimal postoperative morbidities.
Key-words:
Spinal meningioma - thoracic spine - transpedicular-transarticular approach
