Resection of Ventral Thoracic Calcified Meningiomas Through a Transpedicular Approach: 2-Dimensional Operative Video

The surgical resection of ventrally located thoracic lesions carries additional complexity because of the constraints of the mediastinum and pleural cavity as well as the intolerance of the spinal cord to manipulation. The creation of a ventrolateral operative corridor through a transpedicular, transarticular route is effective for accessing the ventral thoracic spinal cord. This operative video demonstrates the surgical management of a 67-yr-old female who presented with progressive gait ataxia and bilateral lower extremity weakness and was found to have noncontiguous calcified ventral thoracic meningiomas at T6 and T10. The surgical plan consisted of T4-11 posterior instrumentation, T5-6 and T9-10 laminectomies with unilateral facetectomies and pediculectomies at both segments, and microsurgical resection of both tumors. Postoperatively, the patient's gait and paraparesis improved. Although instrumentation is infrequently utilized when managing intradural pathology, it permitted aggressive bone removal in order to create an unobstructed ventrolateral corridor to the tumor. This allowed us to perform generous durotomies spanning the length of each lesion and obviated the need for spinal cord manipulation during tumor resection. The patient provided informed consent for the surgery and video recording, and institutional review board approval was determined to be unnecessary.