Innovative dura-splitting strategy for resection of spinal meningioma along with the inner layer of dura mater

Spinal meningioma is a common extramedullary tumor that can theoretically be cured by complete microsurgical resection. However, complete resection of the tumor is challenging with traditional surgical strategies due to the variable relative position of meningioma and spinal cord, as well as the risk of CSF leakage, which leads to high recurrence rates in the long term. The aim of this study was to explore an innovative dura-splitting strategy to resect the tumor, along with the attached inner dural layer, and evaluate the clinical prognosis. The authors retrospectively reviewed cases of spinal meningioma treated using the dura-splitting technique, from 2019 to 2023, and the traditional Simpson grade I resection, from 2016 to 2023. The functional status of patients was assessed preoperatively and postoperatively using the numeric rating scale (NRS) for pain and modified McCormick Scale (mMS) for spinal function. Postoperative complications and tumor recurrence were also recorded. The study included 123 patients with spinal meningiomas, with 97 patients in the dura-splitting group and 26 in the Simpson grade I group. In the dura-splitting group, the mean maximal diameter of the tumors was 20.9 ± 7.5 mm, with 47.4% of tumors located ventrally or ventrolaterally to the spinal cord. The mean follow-up duration for the dura-splitting group was 32.8 ± 18.6 months. At the 6-month follow-up visit, mMS grades showed significant improvement (p < 0.001), with an evident decline in NRS scores in patients with pain (p < 0.001). Compared with the Simpson grade I group, the dura-splitting group demonstrated better pain reduction (p = 0.009). During hospitalization, CSF-related complications were significantly lower in the dura-splitting group (7.2%) compared with the Simpson grade I group (23.1%, p = 0.02). One patient in the Simpson grade I group required revision due to recurrent CSF leakage. No tumor recurrence or other surgical complications were observed in either group at the last follow-up visit. The dura-splitting strategy enabled complete resection of spinal meningioma and circumferential excising of the affected inner layer of dura mater to achieve negative resection margin. In comparison to traditional Simpson grade I resection, this innovative technique offers a favorable prognosis with low complication rates, suggesting it is a valuable addition to the surgical options for spinal meningioma.