Far-Lateral Approach for Ventral and Ventrolateral Upper Cervical Meningiomas: A Case Series and Literature Review

Study Design: Retrospective cohort study. Purpose: To evaluate the safety and efficacy of the far-lateral approach in the resection of ventral and ventrolateral upper cervical meningiomas. Overview of Literature: Upper cervical meningiomas are a common disease entity. These lesions can be surgically treated via many accesses. The far-lateral approach is a very appealing technique for these lesions. Methods: We assessed 23 patients with a mean age of 57.3 +/- 15 years. According to the Japanese Orthopedic Association (JOA) scale; eight patients had grade 0, nine had grade I, and six had grade II. All patients underwent plain radiography and magnetic resonance imaging of the cervical spine. The foramen magnum was involved in 10 patients, C1-2 in seven, C2-3 in four, and C3-4 in two. All patients were operated via the far-lateral approach. Results: Gross total resection was achieved in 21 patients. Sixteen lesions were psammomatous, five were fibroblastic, and two were meningothelial meningiomas. The mean operative duration was 135 +/- 40 minutes, while the mean operative blood loss was 450 +/- 210 ml; and the mean hospital stay was 4.3 +/- 2.2 days. At the final follow-up that was conducted at 27.6 +/- 21 months and as per the JOA score; 16 patients were classified into grade 0 and 7 into grade IL The condition of none of our patients deteriorated postoperatively. There was no significant correlation of the clinical outcome with tumor level, pathological subtype of the tumor, symptom duration, age, and sex. There was no significant correlation of tumor resection completeness with tumor level, tumor pathological subtype, or tumor topography (ventral or ventrolateral). Conclusions: The far-lateral approach is a safe and effective access for ventral and ventrolateral cervical meningiomas. It allows direct access to tumor with no spinal cord or nerve roots traction, and thus may yield a fairly better outcome than the standard posterior approach.