- Department of Neurosurgery, Hospital Privado de Rosario, Argentina.
- Department of Orthopedics, Sanatorio Centro, Rosario, Santa Fe, Argentina.
DOI:10.25259/SNI_383_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Ignacio J. Barrenechea1, Luis M. Marquez1, Marcelo Pastor2. Use of Saito technique to resect an anterior lumbar spine meningioma: Technical note. 14-Jun-2021;12:276
How to cite this URL: Ignacio J. Barrenechea1, Luis M. Marquez1, Marcelo Pastor2. Use of Saito technique to resect an anterior lumbar spine meningioma: Technical note. 14-Jun-2021;12:276. Available from: https://surgicalneurologyint.com/surgicalint-articles/10891/
Background: Complete (Simpson Grade I: total removal) resections for anterior spinal meningiomas are especially challenging. This is largely attributed to difficulty obtaining a water-tight dural repair where the tumor has infiltrated the dura requiring duroplasty, thus often resulting in just a Simpson Grade II resection (i.e. coagulation of the dural implantation site). Here, we present a 56-year-old female who underwent resection of a ventral lumbar meningioma utilizing the Saito technique, that effectively separated the dura into two layers, removing just the inner layer but leaving the outer layer intact for direct dural repair.
Methods: A 56-year-old female underwent a L1–L2 laminectomy. The anterior intradural resection of tumor was achieved with the Saito technique; this required cutting circumferentially around the tumor insertion site, and removing only the inner layer.
Results: Postoperatively, the patient did well without tumor recurrence over 8 years. The postoperative biopsy confirmed a World Health Organization Grade I meningothelial meningioma.
Conclusion: Saito’s technique proved to be a safe and effective method for achieving gross total resection of an anterior lumbar meningioma.
Keywords: Dural preservation, Recurrence, Simpson grade, Spinal meningioma, Surgical technique
Spinal meningiomas represent 25–46% of all spinal intracanalicular tumors.[
In 2001, Saito et al.[
Here, we present a 56-year-old female with an anterior lumbar meningioma that was effectively surgically removed using Saito’s technique.
A 56-year-old female was diagnosed on an enhanced MR with an anterior L1–L3 intradural mass. She had complained of lumbar radiculopathy for the past 3 years and was neurologically intact [
The patient underwent a routine L1–L2 laminectomy. Under the microscope, utilizing a bipolar and micro-scissors, the tumor was resected in a piecemeal fashion; then, the inner portion of the dura was resected leaving the outer dura for closure [
Schematic of the operative technique. (a) The figure shows a cross section of the lumbar spine at the tumor level. (b) Conventional laminectomy was performed to expose the relevant site. After lateral displacement of the cauda equina roots, the tumor was removed with microsurgical technique. (c) After tumor removal, the inner layer of the dura was cut around the tumor implantation site (arrows), dissected away from the outer layer with a # 6 Rhoton dissector, and removed. (d) Primary closure of the posterior dura. Preservation of outer layer of the anterior dura avoided cerebrospinal fluid leakage and pseudomeningocele.
Postoperative (8-year follow-up) contrast-enhanced lumbar spine MRI. (a) T2-weighted sagittal image showing complete resection of the meningioma. (b) Postcontrast fat-saturated T1 sagittal image. No dural tail was seen around the tumor implantation site. (c) T2-weighted axial image showing complete resection of the meningioma. (d) Postcontrast fat saturated T1 axial image at L1–L2 disc level. Note the tenuous dural enhancement at the tumor implantation site following the resection of the inner dural layer. (e and f) Photomicrographs of hematoxylin-eosin stained tissue (original magnification ×10). (e) Meningothelial meningioma. (f)This section shows the dural attachment of the meningioma (T) resected together with the inner layer of the dura (D). Note the tumor invasion only into the innermost part of this layer (black arrowhead), with no signs of compromising the outer potion of the inner layer.
In 2001, Saito et al. published a novel technique to achieve total resection of spinal meningiomas by excising only the inner layer of dura involved, while preserving the outer layer for dural closure.[
Higher tumor recurrence rates for Grade II Simpson resections
Several studies emphasized that Simpson Grade II resections for ventrally located spinal meningiomas resulted in higher tumor recurrence rates. Nakamura et al.[
Lower recurrence rates but higher morbidity with Simpson Grade I meningioma resections
In a retrospective review of 20 patients, Kim et al.[
The Saito technique proved to be a safe and effective method for achieving gross total resection of an anterior-based lumbar spinal benign meningioma.
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