A spinal meningioma is found at the T4 level in a 55-year-old woman presenting with progressive spastic paraparesis and a sensory level. MRI confirms an intradural, extramedullary mass with homogeneous enhancement. Which surgical approach is most appropriate?

• A Posterior laminectomy with intradural tumour excision ✓
• B Anterior approach via thoracotomy and corpectomy
• C Stereotactic radiosurgery (Gamma Knife)
• D Percutaneous vertebroplasty

Explanation

Thoracic spinal meningiomas are intradural and extramedullary, almost always arising from the posterior lateral dura. Posterior laminectomy provides excellent access to the intradural space, allows identification of the dural attachment, and permits complete surgical excision (Simpson Grade I/II) with a high cure rate. Anterior thoracotomy is reserved for intravertebral body or anterior intradural lesions. Radiosurgery is an option for small residual or recurrent meningiomas not amenable to repeat open surgery.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.