A novel dura splitting technique for surgical resection of anterior spinal meningioma: a case series and systematic review of the literature.

introductionRecent research indicates that the extent of tumor resection impacts the recurrence rate of spinal meningiomas, with Simpson grade II resection potentially being inadequate. Simpson grade I resection, which involves full-thickness dura resection, carries a high risk of cerebrospinal fluid (CSF) leak and neurological complications. To mitigate these issues, Saito et al. introduced the dura split (DS) technique in 2001. This method separates the dura into inner and outer layers, allowing the tumor to be removed with the inner layer while preserving the outer layer for primary closure. This approach reduces the risk of CSF leaks and avoids the need for dural graft reconstruction. The DS technique’s safety and efficacy have been validated by subsequent studies.

methodWe retrospectively reviewed medical records for six patients with spinal meningiomas who underwent dura-splitting technique surgeries between 2018 and 2022. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

resultsThe case series included six patients treated between 2018 and 2022 for ventral or ventrolateral spinal meningiomas, predominantly in the thoracic region (4 thoracic, 2 cervical). Surgical approaches included posterior laminectomy in five cases and anterior cervical corpectomy (C4-5) in one. No perioperative complications were reported. The systematic review encompassed nine studies involving 69 patients, with a mean age of 63 years (range: 36–82) and 80.4% female predominance. Most tumors were thoracic (75–82.5%), followed by cervical (15–17.5%) and lumbar (2.5%). The dural splitting technique was the most common surgical approach, minimizing complications and preserving dura integrity. CSF leakage occurred in 1.4% of cases, while tumor recurrence was reported in 5.8%. Neurological recovery was observed in multiple studies, with follow-up durations ranging from 4 months to 19 years.

conclusionOur study confirms the dura-splitting technique as an effective alternative to Simpson grade I and II resections, providing a safer method for radical resection with reduced CSF leak risk.