Circumferential dural reconstruction after excision of recurrent intradural extra medullary spinal meningioma

Abstract

Background: Meningiomas are the most common benign spinal tumor. Surgery is mostly curative, however, ~10% of benign spinal tumors recur. Meningioma recurrence is associated with dural invasion, degree of resection, and histological characteristics of the tumor. Resection of large ventral spinal tumors remains challenging due to a greater risk of spinal cord injury and difficult proper tumor exposure. Surgical resection techniques include en bloc resection of the tumor and involved dura, or tumor resection with extensive coagulation of the dural bed. This is the first report of successful circumferential spinal dural repair using a synthetic dural graft following resection of a recurrent WHO Grade I thoracic spinal meningioma in a pediatric patient. Case description: We report our technique for 360° duraplasty of the thoracic spine following meningioma excision in a pediatric patient. The patient is a neurologically intact 17-year-old female presenting with intradural extra medullary (IDEM) WHO Grade I recurrent ventral thoracic spinal meningioma at the T10–T11 level with intraoperative evidence of nerve root invasion for which complete resection was performed. The resultant 5 cm circumferential dural defect necessitated 360° spinal thoracic duraplasty. No postoperative cerebrospinal fluid leak (CSF) or other complications related to the repair were encountered and the patient returned to baseline neurological status postoperatively. Conclusions: Further follow-up will provide long-term results of this procedure and further research on the application of this technique in dural repair during different surgeries at all spinal levels is warranted. Keywords: Duraplasty, Meningioma, Pediatric, Spine, Surgical technique