Lateral cervical approach for ventrally located upper cervical meningioma: experience of 14 cases with a narrative comparison with other surgical techniques

Abstract

Background

Upper cervical meningioma represents a large portion of intradural extramedullary tumors that occur in the cervical spinal canal. Most of them are located ventrally or ventrolateral to the spinal cord. Reaching lesions at this location surgically is technically challenging.

Objectives

The ideal approach to ventrally located upper cervical lesions continues to be controversial. The aim of this study was to discuss the advantage of the lateral cervical approach and compare it with other surgical routes.

Methods

This retrospective study was conducted on all cases of ventrally located upper cervical meningiomas (C1–C3) who have been operated on using the lateral cervical approach in a tertiary neurosurgery unit between 2006 and 2020. Demographic, clinical, surgical, and follow-up data were collected from hospital records.

Results

During the study period, fourteen patients (Nine females and five males, aged 42–73 years) were recruited. The follow-up period was 2–16 years. The most frequent presenting symptoms were neck pain, occipital headache, motor deficits, and sensory disturbances. Total excision was achieved in all patients. All patients who had preoperative motor deficits improved significantly postoperatively, and those who presented with sensory disturbance had partial recovery. There was neither mortality nor permanent neurological morbidity.

Conclusion

A lateral cervical approach is a safe approach for ventrally located upper cervical lesions. In our series, it offered enough exposure for a safe dissection and total or extensive subtotal removal of the tumors. Retraction or rotation of the neuroaxis was avoided, and the incidence of complications (injury of neural or vascular structures, instability, infection) was very low.

Keywords:

• Far lateral approach
• foramen magnum approach
• lateral cervical approach
• transoral approach
• upper cervical meningioma

Acknowledgements

Open Access funding provided by the Qatar National Library.

Disclosure statement

The authors reported no potential conflict of interest.

Funding

The author(s) reported there is no funding associated with the work featured in this article.