Surgical Outcomes of Ventrally Located Cervical Spinal Meningiomas

Surgical Outcomes of Ventrally Located Cervical Spinal Meningiomas | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Surgical Outcomes of Ventrally Located Cervical Spinal Meningiomas Narihito Nagoshi, Yuichiro Nishiyama, Toshiki Okubo, Masahiro Ozaki, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6222599/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Sep, 2025 Read the published version in Spinal Cord → Version 1 posted 10 You are reading this latest preprint version Abstract Study Design : Retrospective cohort study Objectives : Ventrally located cervical spinal meningiomas present significant surgical challenges due to their proximity to the spinal cord and nerve roots. This study aimed to evaluate the surgical outcomes of these tumors resected via the posterior approach and to compare them with dorsolaterally located meningiomas. Setting : The single institution in Japan. Methods : A retrospective review was conducted on 39 patients who underwent posterior surgical resection of cervical spinal meningiomas between 2008 and 2023, with a minimum follow-up of one year. Patients were classified into ventral (n = 17) and dorsolateral (n = 22) groups based on tumor localization. Neurological function was assessed using the Japanese Orthopedic Association (JOA) score, and surgical outcomes were compared. Results : The groups had no significant differences in operative time or blood loss. However, nerve root resection was significantly more frequent in the ventral group (41.2% vs. 9.1%, p = 0.02), and perioperative complications were more common (41.2% vs. 13.6%, p = 0.06). Although postoperative JOA scores were lower in the ventral group (14.6 ± 0.6 vs. 16.4 ± 0.3, p = 0.01), both groups showed significant postoperative improvement compared to preoperative scores (p < 0.01). Conclusions : Despite the higher risk of nerve root sacrifice and limited neurological recovery associated with the posterior approach, considering the functional improvements from baseline, it remains a viable surgical option for ventrally located cervical meningiomas. Further studies comparing different surgical approaches are needed to optimize treatment strategies. Health sciences/Medical research/Outcomes research Health sciences/Neurology/Neurological disorders/Spinal cord diseases Introduction Meningiomas account for approximately 12–25% of intradural tumors at the spinal level. 1 – 3 While meningiomas predominantly arise in the thoracic spine (67–84%), their occurrence in the cervical spine is relatively rare, with a reported frequency of approximately 15–30%. 2 Although meningiomas are generally benign and slow-growing, they can progressively enlarge, leading to spinal cord compression and progressive neurological deficits. Therefore, surgical resection remains the first-line treatment option when clinical symptoms emerge. However, the surgical complexity of meningiomas varies significantly depending on their location. In particular, ventrally located spinal meningiomas are considered especially challenging to resect. 4 – 7 For cervical meningiomas, surgical approaches include the anterior, posterolateral, and posterior approaches, each with distinct advantages and disadvantages. 5 , 8 – 10 Among these, while we occasionally employ the anterior approach, our primary choice is the posterior approach. This technique facilitates dural and spinal cord exposure, but accessing ventrally located tumors can occasionally be difficult due to the cervical enlargement and the nerve roots responsible for upper limb function. 11 Several previous studies have reported surgical outcomes for ventrally located cervical meningiomas using various approaches. 4 – 6 , 8 – 10 , 12 However, the majority of these studies include tumors located at the thoracic spinal level and primarily consist of case series without a comparative control group. As a result, accurately assessing the treatment outcomes of ventrally located cervical meningiomas remains challenging. To address this gap, the present study aims to assess the surgical outcomes of ventrally located meningiomas at the cervical level using the posterior approach, with dorsally located meningiomas serving as the control group for comparison, and to evaluate the indications and limitations of the posterior approach. Materials and Methods Study Design and Subjects We retrospectively reviewed the patients with surgical treatment for cervical meningioma. Fifty patients underwent surgery between 2008 and 2023. Thirty-nine of these patients who underwent initial surgery by posterior approach and could be followed up for at least one year after surgery were included in this study. All surgeries were performed by one of 4 board-certified spine surgeons. This study was approved by the review board at our institution, and all subjects consented and agreed with its inclusion. Extensive data were collected for each participant, including demographic information, medical history, magnetic resonance imaging (MRI) findings, and surgery. The meningioma was finally diagnosed by pathological evidence after surgical resection. Neurological status was evaluated using the Japanese Orthopedic Association scoring system (JOA score). 13 The recovery rate was calculated using the formula: (postoperative JOA score - preoperative JOA score)/(17 - preoperative JOA score) × 100 (%). The utility of the JOA score for intradural spinal tumors has already been reported in previous studies. 14 , 15 The tumor localization was classified into the dorsal, lateral, and ventral type depending on the localization of the dural attachment of the tumor. 3 The dural attachment of the tumor was determined by preoperative MRI and intraoperative observation. Based on these findings, the patients were categorized into two groups based on tumor location: the ventral group (n = 17) and the dorsolateral group (n = 22). Statistical analysis Continuous variables are expressed as means ± standard deviation, while categorical variables are presented as percentages. An unpaired t-test was employed to compare continuous variables between the groups, and a chi-square test was used for categorical variables. A paired t-test was used to evaluate the effect size using the JOA scores pre- and postoperatively. All statistical analyses were performed using SPSS version 29.0 (SPSS Inc., Chicago, IL). A P-value of < 0.05 was considered statistically significant. Results Patient Characteristics and Imaging Findings Table 1 summarizes the baseline characteristics and imaging findings of the study cohort. The mean age at the time of surgery was 59.4 ± 3.4 years in the ventral group and 54.0 ± 2.9 years in the dorsolateral group (p = 0.27). The proportion of male patients was less than half in both groups (41.2% vs. 31.8%), with no significant difference (p = 0.55). In both groups, the most common tumor location in the cervical spine was at the C3-4 level (p = 0.48). As assessed by the JOA score, preoperative neurological function showed no significant differences, with scores of 12.0 ± 0.9 in the ventral group and 12.5 ± 0.8 in the dorsolateral group (p = 0.64). Surgical Outcomes and Perioperative Factors No significant differences were observed in operative time (ventral: 265.9 ± 24.0 min vs. dorsolateral: 268.3 ± 18.1 min, p = 0.93) or intraoperative blood loss (ventral: 139.7 ± 42.6 mL vs. dorsolateral: 141.1 ± 27.0 mL, p = 0.97) (Table 2). However, the proportion of cases requiring nerve root resection during tumor removal was significantly higher in the ventral group compared to the dorsolateral group (41.2% vs. 9.1%, p = 0.02). The details regarding the site of the severed nerve root and the corresponding responsible spinal level are summarized in Table 3. In the majority of cases, no symptoms attributable to the transection were observed. However, postoperative deltoid muscle paralysis occurred in two patients who underwent C5 ventral root transection. Preoperatively, both patients had a manual muscle testing (MMT) grade of 5 for the deltoid muscle, which declined to grade 2 postoperatively. One patient achieved complete recovery of muscle strength, while the other improved to an MMT grade of 4. At the final follow-up, both patients had no issues with activities of daily living (ADL). The Simpson grade classification of tumor resection showed no significant differences between groups, with Simpson grade I achieved in 52.9% of ventral cases and 63.6% of dorsolateral cases (p = 0.25) (Table 2). Perioperative complications were observed in 7 cases (41.2%) in the ventral group and 3 cases (13.6%) in the dorsolateral group (p = 0.06). In the ventral group, the complications included muscle weakness in 6 cases, and cerebrospinal fluid leakage in 1 case. In the dorsolateral group, postoperative hydrocephalus occurred in 2 cases, and cerebrospinal fluid leakage was observed in 1 case. All histological tumor subtypes were World Health Organization grade I. The length of hospital stay was 29.5 ± 3.4 days in the ventral group and 25.1 ± 2.9 days in the dorsolateral group (p = 0.34). Postoperative Neurological Outcomes and Follow-up Postoperative JOA scores were significantly lower in the ventral group (14.6 ± 0.6) than in the dorsolateral group (16.4 ± 0.3) (p = 0.01) (Table 4). However, postoperative JOA scores showed significant improvements in both groups compared to preoperative scores (p < 0.01). The JOA score recovery rate tended to be lower in the ventral group (35.2 ± 23.0%) compared to the dorsolateral group (76.5 ± 7.9%), although the difference did not reach statistical significance (p = 0.1). No tumor recurrence was observed in either group during the follow-up period. The mean follow-up duration was similar between the two groups (ventral: 57.1 ± 8.8 months vs. dorsolateral: 60.6 ± 7.8 months, p = 0.76). Discussion To the best of our knowledge, this study is the first to compare and evaluate the treatment outcomes of ventrally located spinal meningiomas in comparison to dorsally located tumors. The results demonstrated that while surgical resection of ventrally located cervical meningiomas via the posterior approach is feasible, nerve root resection was frequently required both to access the tumor and to manage the dural attachment of the tumor. During tumor resection, surgical manipulation on the ventral side imposes a burden on the spinal cord, potentially leading to unfavorable effects on neurological function. Consequently, the incidence of postoperative complications tended to be higher, and postoperative neurological recovery was significantly lower in the ventral group compared to the dorsolateral group. Despite these differences, postoperative neurological improvement relative to baseline severity was observed even in ventrally located tumors, and no cases of tumor recurrence were documented. These findings support the moderate efficacy of the posterior approach for ventrally located spinal meningiomas. Considering the limited functional recovery and the incidence of postoperative complications, the posterior approach may not always be the optimal choice for resecting ventrally located cervical meningiomas. However, to date, no studies, including ours, have conducted a direct comparison between the posterior approach and other surgical approaches, such as the anterior or posterolateral approach. Therefore, it is premature to conclude that the posterior approach is inferior. The anterior approach offers a significant advantage in that it allows direct access to the tumor without manipulating the spinal cord. 9 , 16 However, it presents challenges due to the narrow surgical field, making the procedure technically demanding. Additionally, anterior fixation is required, which inevitably increases the risk of postoperative complications. 17 , 18 The posterolateral approach, while facilitating easier access to the tumor compared to the posterior approach, carries the risk of vertebral artery injury and does not offer a distinct advantage in terms of nerve root management compared to the posterior approach. 11 , 19 Although each surgical approach has its own advantages and limitations, it is noteworthy that postoperative neurological recovery was achieved using the posterior approach employed in this study. Future comparative studies assessing different surgical techniques may provide further insights into the most effective approach for resecting ventrally located cervical meningiomas. In our previous study, when meningiomas were resected with Simpson grade I, no cases of recurrence were observed during a mean postoperative follow-up period of 12 years on average. 3 Therefore, we aim to achieve Simpson grade I resection for meningiomas whenever possible. However, when the tumor is located on the ventral side of the spinal cord, complete dural resection can be challenging occasionally. Consequently, in several cases, surgery was concluded with Simpson grade II resection, where only coagulation of the dural attachment was performed instead of full-thickness dural excision. Although no recurrence has been observed to date, considering that the follow-up period in the present study is approximately five years, continued careful observation remains crucial. In this study, the number of cases requiring nerve root transection was significantly higher in the ventral group. This finding suggests that, in the context of a posterior approach, situations may arise in which tumor resection is not feasible without sacrificing the nerve root. However, the symptoms resulting from nerve root transection vary considerably depending on the cervical spinal level. Although a previous study focused on dumbbell-type schwannomas rather than meningiomas, Nakamura et al. reported that transection of the C5 and C8 nerve roots was more likely to result in motor deficits, whereas transection of the C2 and C8 nerve roots was associated with a higher incidence of sensory disturbances. 15 Other nerve roots either do not cause symptoms when transected or, if symptoms do appear, they are often temporary. Similarly, in our study, nerve root transection did not result in symptoms in most cases. However, both patients who underwent C5 anterior root transection experienced postoperative muscle weakness. The deltoid muscle is primarily innervated by the C5 nerve root and receives minimal compensatory innervation from adjacent levels, which likely contributes to the severe functional impairment observed following its transection. On the other hand, in the present cases, both patients demonstrated muscle strength recovery with minimal limitations in ADL. Therefore, even when a meningioma encases the C5 nerve root and its transection is unavoidable, postoperative rehabilitation and other conservative treatments may contribute to functional improvement. This study has several limitations. First, as a retrospective study with a limited sample size, its level of evidence is not high. Further accumulation of cases is necessary to reassess the findings obtained in this study. Second, while the resection of ventrally located meningiomas is technically challenging, the procedures were performed by multiple surgeons. Variations in surgical skill and experience may have influenced the surgical outcomes. Finally, there were no standardized criteria for surgical indications, postoperative rehabilitation, or pharmacological treatment. Given that the study spans a 15-year period, changes in treatment strategies over time may have impacted the outcomes. Despite these limitations, this study represents the first case-control study evaluating ventrally located cervical meningiomas. Based on these findings, further investigations aimed at establishing safer and more effective treatment strategies are warranted. In conclusion, this study evaluated the surgical outcomes of ventrally located cervical meningiomas resected via the posterior approach, comparing them to dorsolaterally located meningiomas. In cases requiring ventral tumor resection, some patients necessitated nerve root transection, and postoperative neurological recovery was more limited compared to dorsolateral tumors. However, significant functional improvement was still achieved postoperatively. These findings suggest that the posterior approach remains a viable surgical option for ventrally located cervical meningiomas. Declarations ETHICS APPROVAL: This study received ethical approval from the institutional review board (20110142). We certify that all applicable institutional regulations concerning the ethical use of human volunteers were followed during the course of this research. COMPETING INTERESTS: The authors declare no competing interests. ADDITIONAL INFORMATION: Correspondence and requests for materials should be addressed to N.N. FUNDING: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. AUTHOR CONTRIBUTIONS: Y.N. and N.N. designed the research; Y.N. analyzed the data and wrote the paper; N.N. and M.N. performed data collection; T.O., M.O., S.S., K.T., T.I., M.M., M.N. and K.W. supervised the study; all authors reviewed and approved the manuscript. ACKNOWLEDGEMENT: In preparing this manuscript, ChatGPT (OpenAI) and Grammarly (Grammarly Inc.) were used for grammar refinement and typographical error correction. These tools were employed exclusively to improve clarity and readability, without modifying the scientific content or interpretation of the findings. References Nagoshi N, Okubo T, Ozaki M, Suzuki S, Takeda K, Iga T et al. Epidemiology and surgical outcomes of pediatric intradural spinal tumors: results from a retrospective series of patients operated in the first two decades of life. Spinal Cord 2025; 63 (2) : 75-79. Hohenberger C, Hau P, Schebesch KM, Kolbl O, Riemenschneider MJ, Pohl F et al. Spinal meningiomas. Neurooncol Adv 2023; 5 (Suppl 1) : i112-i121. Nakamura M, Tsuji O, Fujiyoshi K, Hosogane N, Watanabe K, Tsuji T et al. Long-term surgical outcomes of spinal meningiomas. Spine (Phila Pa 1976) 2012; 37 (10) : E617-23. Tola S, De Angelis M, Bistazzoni S, Chiaramonte C, Esposito V, Paolini S. Hemilaminectomy for spinal meningioma: A case series of 20 patients with a focus on ventral- and ventrolateral lesions. Clin Neurol Neurosurg 2016; 148: 35-41. Takami T, Naito K, Yamagata T, Yoshimura M, Arima H, Ohata K. Posterolateral approach for spinal intradural meningioma with ventral attachment. J Craniovertebr Junction Spine 2015; 6 (4) : 173-8. Sarikaya C, Ramazanoglu AF, Yaltirik CK, Etli MU, Onen MR, Naderi S. Short-Term Results of Simpson Grade 2 Resection in Spinal Meningiomas. World Neurosurg 2023; 171: e792-e795. Haddad AF, Safaee MM, Pereira MP, Oh JY, Lau D, Tan LA et al. Posterior-based resection of spinal meningiomas: an institutional experience of 141 patients with an average of 28 months of follow-up. J Neurosurg Spine 2023; 38 (1) : 139-146. Notani N, Miyazaki M, Kanezaki S, Ishihara T, Kawano M, Tsumura H. Surgical management of ventrally located spinal meningiomas via posterior approach. Eur J Orthop Surg Traumatol 2017; 27 (2) : 181-186. Fraioli MF, Marciani MG, Umana GE, Fraioli B. Anterior Microsurgical Approach to Ventral Lower Cervical Spine Meningiomas: Indications, Surgical Technique and Long Term Outcome. Technol Cancer Res Treat 2015; 14 (4) : 505-10. Eroglu U, Bahadir B, Tomlinson SB, Ugur HC, Sayaci EY, Attar A et al. Microsurgical Management of Ventral Intradural-Extramedullary Cervical Meningiomas: Technical Considerations and Outcomes. World Neurosurg 2020; 135: e748-e753. Angevine PD, Kellner C, Haque RM, McCormick PC. Surgical management of ventral intradural spinal lesions. J Neurosurg Spine 2011; 15 (1) : 28-37. Chen H, Fu YN, Fu CD. Safety and efficacy of posterior approach for resection of spinal meningioma: Impact of dural attachment location. World J Clin Cases 2024; 12 (36) : 6905-6915. Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976) 1981; 6 (4) : 354-64. Nagoshi N, Tsuji O, Nakashima D, Takeuchi A, Kameyama K, Okada E et al. Clinical outcomes and prognostic factors for cavernous hemangiomas of the spinal cord: a retrospective cohort study. J Neurosurg Spine 2019; 31 (2) : 271-278. Nakamura M, Iwanami A, Tsuji O, Hosogane N, Watanabe K, Tsuji T et al. Long-term surgical outcomes of cervical dumbbell neurinomas. J Orthop Sci 2013; 18 (1) : 8-13. Radek M, Grochal M, Tomasik B, Radek A. The antero-lateral approach with corpectomy in the management of the ventral meningioma of the spinal canal. Neurol Neurochir Pol 2016; 50 (3) : 226-30. Yoshii T, Egawa S, Hirai T, Kaito T, Mori K, Koda M et al. A systematic review and meta-analysis comparing anterior decompression with fusion and posterior laminoplasty for cervical ossification of the posterior longitudinal ligament. J Orthop Sci 2020; 25 (1) : 58-65. Yoshii T, Egawa S, Chikuda H, Wakao N, Furuya T, Kanchiku T et al. Comparison of anterior decompression with fusion and posterior decompression with fusion for cervical spondylotic myelopathy-A systematic review and meta-analysis. J Orthop Sci 2020; 25 (6) : 938-945. Aboul-Enein HA, Khidr WM, Abdeen KM, Madawi AA. Surgical management of ventrally based lower cervical (subaxial) meningiomas through the lateral approach: Report on 16 cases. Clin Neurol Neurosurg 2015; 139: 152-8. Tables Table 1 Demographics and imaging findings Ventral (n=17) Dorsolateral (n=22) P-value Age (years) 59.4 ± 3.4 54.0 ± 2.9 0.27 Gender (% male) 41.2 31.8 0.55 Location (%) C1-2 C3-4 C5-7 23.5 47.1 29.4 27.3 59.1 13.6 0.48 Preoperative JOA score 12.0 ± 0.9 12.5 ± 0.8 0.64 JOA: Japanese Orthopedic Association. Table 2 Surgical information Ventral (n=17) Dorsolateral (n=22) P-value Operative time (minutes) 265.9 ± 24.0 268.3 ± 18.1 0.93 Blood loss (ml) 139.7 ±42.6 141.1 ± 27.0 0.97 Nerve root resection (%) 41.2 9.1 0.02 Simpson grade (%) I II III IV 52.9 35.3 0.0 11.8 63.6 36.4 0.0 0.0 0.25 Perioperative complications (%) 41.2 13.6 0.06 Length of hospital stay (days) 29.5 ± 3.4 25.1 ± 2.9 0.34 JOA: Japanese Orthopedic Association. Table 3 Details of the cases requiring nerve root resection Case Location of the tumor Level of transected nerve root Symptoms following nerve root transection 1 Ventral C7 (dorsal and ventral roots) None 2 Ventral C3 (dorsal root) None 3 Ventral C5 (dorsal and ventral roots) Temporary paralysis of the deltoid muscle 4 Ventral C5 (dorsal root) None 5 Ventral C4 (dorsal and ventral roots) None 6 Ventral C5 (dorsal and ventral roots) C6 (dorsal root) Permanent paralysis of the deltoid muscle 7 Ventral C2 (dorsal and ventral roots) None 8 Dorsolateral C3 (dorsal and ventral roots) None 9 Dorsolateral C4 (dorsal root) None Table 4 Clinical outcomes Ventral (n=17) Dorsolateral (n=22) P-value Postoperative JOA score 14.6 ± 0.6 16.4 ± 0.3 0.01 Recovery rate of JOA score (%) 35.2 ± 23.0 76.5 ± 7.9 0.10 Tumor recurrence (%) 0.0 0.0 - Follow-up period (months) 57.1 ± 8.8 60.6 ±7.8 0.76 JOA: Japanese Orthopedic Association. Additional Declarations There is no duality of interest Cite Share Download PDF Status: Published Journal Publication published 24 Sep, 2025 Read the published version in Spinal Cord → Version 1 posted Editorial decision: revise 29 Apr, 2025 Review # 1 received at journal 10 Apr, 2025 Review # 2 received at journal 01 Apr, 2025 Reviewer # 2 agreed at journal 20 Mar, 2025 Reviewer # 1 agreed at journal 19 Mar, 2025 Reviewers invited by journal 18 Mar, 2025 Submission checks completed at journal 17 Mar, 2025 First submitted to journal 15 Mar, 2025 Unknown event 14 Mar, 2025 Editor assigned by journal 13 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6222599","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":430633095,"identity":"3eaa565f-d117-40a3-bb1e-f05e48878491","order_by":0,"name":"Narihito 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21:15:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6222599/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6222599/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41393-025-01118-5","type":"published","date":"2025-09-24T04:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92146813,"identity":"5c16cfeb-52ce-4d4c-8ee8-cb5deeb63ac9","added_by":"auto","created_at":"2025-09-25 07:17:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":591674,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6222599/v1/7667e47d-a6c2-4993-a7e0-aa5640520a8c.pdf"}],"financialInterests":"There is no duality of interest","formattedTitle":"Surgical Outcomes of Ventrally Located Cervical Spinal Meningiomas","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMeningiomas account for approximately 12\u0026ndash;25% of intradural tumors at the spinal level.\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e While meningiomas predominantly arise in the thoracic spine (67\u0026ndash;84%), their occurrence in the cervical spine is relatively rare, with a reported frequency of approximately 15\u0026ndash;30%.\u003csup\u003e2\u003c/sup\u003e Although meningiomas are generally benign and slow-growing, they can progressively enlarge, leading to spinal cord compression and progressive neurological deficits. Therefore, surgical resection remains the first-line treatment option when clinical symptoms emerge.\u003c/p\u003e \u003cp\u003eHowever, the surgical complexity of meningiomas varies significantly depending on their location. In particular, ventrally located spinal meningiomas are considered especially challenging to resect.\u003csup\u003e\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e For cervical meningiomas, surgical approaches include the anterior, posterolateral, and posterior approaches, each with distinct advantages and disadvantages.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Among these, while we occasionally employ the anterior approach, our primary choice is the posterior approach. This technique facilitates dural and spinal cord exposure, but accessing ventrally located tumors can occasionally be difficult due to the cervical enlargement and the nerve roots responsible for upper limb function.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSeveral previous studies have reported surgical outcomes for ventrally located cervical meningiomas using various approaches.\u003csup\u003e\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e However, the majority of these studies include tumors located at the thoracic spinal level and primarily consist of case series without a comparative control group. As a result, accurately assessing the treatment outcomes of ventrally located cervical meningiomas remains challenging. To address this gap, the present study aims to assess the surgical outcomes of ventrally located meningiomas at the cervical level using the posterior approach, with dorsally located meningiomas serving as the control group for comparison, and to evaluate the indications and limitations of the posterior approach.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Subjects\u003c/h2\u003e \u003cp\u003eWe retrospectively reviewed the patients with surgical treatment for cervical meningioma. Fifty patients underwent surgery between 2008 and 2023. Thirty-nine of these patients who underwent initial surgery by posterior approach and could be followed up for at least one year after surgery were included in this study. All surgeries were performed by one of 4 board-certified spine surgeons. This study was approved by the review board at our institution, and all subjects consented and agreed with its inclusion.\u003c/p\u003e \u003cp\u003eExtensive data were collected for each participant, including demographic information, medical history, magnetic resonance imaging (MRI) findings, and surgery. The meningioma was finally diagnosed by pathological evidence after surgical resection. Neurological status was evaluated using the Japanese Orthopedic Association scoring system (JOA score).\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e The recovery rate was calculated using the formula: (postoperative JOA score - preoperative JOA score)/(17 - preoperative JOA score) \u0026times; 100 (%). The utility of the JOA score for intradural spinal tumors has already been reported in previous studies.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe tumor localization was classified into the dorsal, lateral, and ventral type depending on the localization of the dural attachment of the tumor.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e The dural attachment of the tumor was determined by preoperative MRI and intraoperative observation. Based on these findings, the patients were categorized into two groups based on tumor location: the ventral group (n\u0026thinsp;=\u0026thinsp;17) and the dorsolateral group (n\u0026thinsp;=\u0026thinsp;22).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, while categorical variables are presented as percentages. An unpaired t-test was employed to compare continuous variables between the groups, and a chi-square test was used for categorical variables. A paired t-test was used to evaluate the effect size using the JOA scores pre- and postoperatively. All statistical analyses were performed using SPSS version 29.0 (SPSS Inc., Chicago, IL). A P-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003ePatient Characteristics and Imaging Findings\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 summarizes the baseline characteristics and imaging findings of the study cohort. The mean age at the time of surgery was 59.4 \u0026plusmn; 3.4 years in the ventral group and 54.0 \u0026plusmn; 2.9 years in the dorsolateral group (p = 0.27). The proportion of male patients was less than half in both groups (41.2% vs. 31.8%), with no significant difference (p = 0.55). In both groups, the most common tumor location in the cervical spine was at the C3-4 level (p = 0.48). As assessed by the JOA score, preoperative neurological function showed no significant differences, with scores of 12.0 \u0026plusmn; 0.9 in the ventral group and 12.5 \u0026plusmn; 0.8 in the dorsolateral group (p = 0.64).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSurgical Outcomes and Perioperative Factors\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo significant differences were observed in operative time (ventral: 265.9 \u0026plusmn; 24.0 min vs. dorsolateral: 268.3 \u0026plusmn; 18.1 min, p = 0.93) or intraoperative blood loss (ventral: 139.7 \u0026plusmn; 42.6 mL vs. dorsolateral: 141.1 \u0026plusmn; 27.0 mL, p = 0.97) (Table 2). However, the proportion of cases requiring nerve root resection during tumor removal was significantly higher in the ventral group compared to the dorsolateral group (41.2% vs. 9.1%, p = 0.02).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe details regarding the site of the severed nerve root and the corresponding responsible spinal level are summarized in Table 3. In the majority of cases, no symptoms attributable to the transection were observed. However, postoperative deltoid muscle paralysis occurred in two patients who underwent C5 ventral root transection. Preoperatively, both patients had a manual muscle testing (MMT) grade of 5 for the deltoid muscle, which declined to grade 2 postoperatively. One patient achieved complete recovery of muscle strength, while the other improved to an MMT grade of 4. At the final follow-up, both patients had no issues with activities of daily living (ADL).\u003c/p\u003e\n\u003cp\u003eThe Simpson grade classification of tumor resection showed no significant differences between groups, with Simpson grade I achieved in 52.9% of ventral cases and 63.6% of dorsolateral cases (p = 0.25) (Table 2). Perioperative complications were observed in 7 cases (41.2%) in the ventral group and 3 cases (13.6%) in the dorsolateral group (p = 0.06). In the ventral group, the complications included muscle weakness in 6 cases, and cerebrospinal fluid leakage in 1 case. In the dorsolateral group, postoperative hydrocephalus occurred in 2 cases, and cerebrospinal fluid leakage was observed in 1 case. All histological tumor subtypes were World Health Organization grade I. The length of hospital stay was 29.5 \u0026plusmn; 3.4 days in the ventral group and 25.1 \u0026plusmn; 2.9 days in the dorsolateral group (p = 0.34).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePostoperative Neurological Outcomes and Follow-up\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePostoperative JOA scores were significantly lower in the ventral group (14.6 \u0026plusmn; 0.6) than in the dorsolateral group (16.4 \u0026plusmn; 0.3) (p = 0.01) (Table 4). However, postoperative JOA scores showed significant improvements in both groups compared to preoperative scores (p \u0026lt; 0.01). The JOA score recovery rate tended to be lower in the ventral group (35.2 \u0026plusmn; 23.0%) compared to the dorsolateral group (76.5 \u0026plusmn; 7.9%), although the difference did not reach statistical significance (p = 0.1). No tumor recurrence was observed in either group during the follow-up period. The mean follow-up duration was similar between the two groups (ventral: 57.1 \u0026plusmn; 8.8 months vs. dorsolateral: 60.6 \u0026plusmn; 7.8 months, p = 0.76).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this study is the first to compare and evaluate the treatment outcomes of ventrally located spinal meningiomas in comparison to dorsally located tumors. The results demonstrated that while surgical resection of ventrally located cervical meningiomas via the posterior approach is feasible, nerve root resection was frequently required both to access the tumor and to manage the dural attachment of the tumor. During tumor resection, surgical manipulation on the ventral side imposes a burden on the spinal cord, potentially leading to unfavorable effects on neurological function. Consequently, the incidence of postoperative complications tended to be higher, and postoperative neurological recovery was significantly lower in the ventral group compared to the dorsolateral group. Despite these differences, postoperative neurological improvement relative to baseline severity was observed even in ventrally located tumors, and no cases of tumor recurrence were documented. These findings support the moderate efficacy of the posterior approach for ventrally located spinal meningiomas.\u003c/p\u003e \u003cp\u003eConsidering the limited functional recovery and the incidence of postoperative complications, the posterior approach may not always be the optimal choice for resecting ventrally located cervical meningiomas. However, to date, no studies, including ours, have conducted a direct comparison between the posterior approach and other surgical approaches, such as the anterior or posterolateral approach. Therefore, it is premature to conclude that the posterior approach is inferior. The anterior approach offers a significant advantage in that it allows direct access to the tumor without manipulating the spinal cord.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e However, it presents challenges due to the narrow surgical field, making the procedure technically demanding. Additionally, anterior fixation is required, which inevitably increases the risk of postoperative complications.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e The posterolateral approach, while facilitating easier access to the tumor compared to the posterior approach, carries the risk of vertebral artery injury and does not offer a distinct advantage in terms of nerve root management compared to the posterior approach.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Although each surgical approach has its own advantages and limitations, it is noteworthy that postoperative neurological recovery was achieved using the posterior approach employed in this study. Future comparative studies assessing different surgical techniques may provide further insights into the most effective approach for resecting ventrally located cervical meningiomas.\u003c/p\u003e \u003cp\u003eIn our previous study, when meningiomas were resected with Simpson grade I, no cases of recurrence were observed during a mean postoperative follow-up period of 12 years on average.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Therefore, we aim to achieve Simpson grade I resection for meningiomas whenever possible. However, when the tumor is located on the ventral side of the spinal cord, complete dural resection can be challenging occasionally. Consequently, in several cases, surgery was concluded with Simpson grade II resection, where only coagulation of the dural attachment was performed instead of full-thickness dural excision. Although no recurrence has been observed to date, considering that the follow-up period in the present study is approximately five years, continued careful observation remains crucial.\u003c/p\u003e \u003cp\u003eIn this study, the number of cases requiring nerve root transection was significantly higher in the ventral group. This finding suggests that, in the context of a posterior approach, situations may arise in which tumor resection is not feasible without sacrificing the nerve root. However, the symptoms resulting from nerve root transection vary considerably depending on the cervical spinal level. Although a previous study focused on dumbbell-type schwannomas rather than meningiomas, Nakamura et al. reported that transection of the C5 and C8 nerve roots was more likely to result in motor deficits, whereas transection of the C2 and C8 nerve roots was associated with a higher incidence of sensory disturbances.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Other nerve roots either do not cause symptoms when transected or, if symptoms do appear, they are often temporary. Similarly, in our study, nerve root transection did not result in symptoms in most cases. However, both patients who underwent C5 anterior root transection experienced postoperative muscle weakness. The deltoid muscle is primarily innervated by the C5 nerve root and receives minimal compensatory innervation from adjacent levels, which likely contributes to the severe functional impairment observed following its transection. On the other hand, in the present cases, both patients demonstrated muscle strength recovery with minimal limitations in ADL. Therefore, even when a meningioma encases the C5 nerve root and its transection is unavoidable, postoperative rehabilitation and other conservative treatments may contribute to functional improvement.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, as a retrospective study with a limited sample size, its level of evidence is not high. Further accumulation of cases is necessary to reassess the findings obtained in this study. Second, while the resection of ventrally located meningiomas is technically challenging, the procedures were performed by multiple surgeons. Variations in surgical skill and experience may have influenced the surgical outcomes. Finally, there were no standardized criteria for surgical indications, postoperative rehabilitation, or pharmacological treatment. Given that the study spans a 15-year period, changes in treatment strategies over time may have impacted the outcomes. Despite these limitations, this study represents the first case-control study evaluating ventrally located cervical meningiomas. Based on these findings, further investigations aimed at establishing safer and more effective treatment strategies are warranted.\u003c/p\u003e \u003cp\u003eIn conclusion, this study evaluated the surgical outcomes of ventrally located cervical meningiomas resected via the posterior approach, comparing them to dorsolaterally located meningiomas. In cases requiring ventral tumor resection, some patients necessitated nerve root transection, and postoperative neurological recovery was more limited compared to dorsolateral tumors. However, significant functional improvement was still achieved postoperatively. These findings suggest that the posterior approach remains a viable surgical option for ventrally located cervical meningiomas.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eETHICS APPROVAL:\u003c/h2\u003e \u003cp\u003eThis study received ethical approval from the institutional review board (20110142). We certify that all applicable institutional regulations concerning the ethical use of human volunteers were followed during the course of this research.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCOMPETING INTERESTS:\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eADDITIONAL INFORMATION:\u003c/h2\u003e \u003cp\u003eCorrespondence and requests for materials should be addressed to N.N.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFUNDING:\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAUTHOR CONTRIBUTIONS:\u003c/h2\u003e \u003cp\u003eY.N. and N.N. designed the research; Y.N. analyzed the data and wrote the paper; N.N. and M.N. performed data collection; T.O., M.O., S.S., K.T., T.I., M.M., M.N. and K.W. supervised the study; all authors reviewed and approved the manuscript.\u003c/p\u003e\u003ch2\u003eACKNOWLEDGEMENT:\u003c/h2\u003e \u003cp\u003eIn preparing this manuscript, ChatGPT (OpenAI) and Grammarly (Grammarly Inc.) were used for grammar refinement and typographical error correction. These tools were employed exclusively to improve clarity and readability, without modifying the scientific content or interpretation of the findings.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNagoshi N, Okubo T, Ozaki M, Suzuki S, Takeda K, Iga T\u003cem\u003e et al.\u003c/em\u003e Epidemiology and surgical outcomes of pediatric intradural spinal tumors: results from a retrospective series of patients operated in the first two decades of life. \u003cem\u003eSpinal Cord \u003c/em\u003e2025; \u003cstrong\u003e63\u003c/strong\u003e(2)\u003cstrong\u003e: \u003c/strong\u003e75-79.\u003c/li\u003e\n\u003cli\u003eHohenberger C, Hau P, Schebesch KM, Kolbl O, Riemenschneider MJ, Pohl F\u003cem\u003e et al.\u003c/em\u003e Spinal meningiomas. \u003cem\u003eNeurooncol Adv \u003c/em\u003e2023; \u003cstrong\u003e5\u003c/strong\u003e(Suppl 1)\u003cstrong\u003e: \u003c/strong\u003ei112-i121.\u003c/li\u003e\n\u003cli\u003eNakamura M, Tsuji O, Fujiyoshi K, Hosogane N, Watanabe K, Tsuji T\u003cem\u003e et al.\u003c/em\u003e Long-term surgical outcomes of spinal meningiomas. \u003cem\u003eSpine (Phila Pa 1976) \u003c/em\u003e2012; \u003cstrong\u003e37\u003c/strong\u003e(10)\u003cstrong\u003e: \u003c/strong\u003eE617-23.\u003c/li\u003e\n\u003cli\u003eTola S, De Angelis M, Bistazzoni S, Chiaramonte C, Esposito V, Paolini S. 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Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. \u003cem\u003eSpine (Phila Pa 1976) \u003c/em\u003e1981; \u003cstrong\u003e6\u003c/strong\u003e(4)\u003cstrong\u003e: \u003c/strong\u003e354-64.\u003c/li\u003e\n\u003cli\u003eNagoshi N, Tsuji O, Nakashima D, Takeuchi A, Kameyama K, Okada E\u003cem\u003e et al.\u003c/em\u003e Clinical outcomes and prognostic factors for cavernous hemangiomas of the spinal cord: a retrospective cohort study. \u003cem\u003eJ Neurosurg Spine \u003c/em\u003e2019; \u003cstrong\u003e31\u003c/strong\u003e(2)\u003cstrong\u003e: \u003c/strong\u003e271-278.\u003c/li\u003e\n\u003cli\u003eNakamura M, Iwanami A, Tsuji O, Hosogane N, Watanabe K, Tsuji T\u003cem\u003e et al.\u003c/em\u003e Long-term surgical outcomes of cervical dumbbell neurinomas. \u003cem\u003eJ Orthop Sci \u003c/em\u003e2013; \u003cstrong\u003e18\u003c/strong\u003e(1)\u003cstrong\u003e: \u003c/strong\u003e8-13.\u003c/li\u003e\n\u003cli\u003eRadek M, Grochal M, Tomasik B, Radek A. The antero-lateral approach with corpectomy in the management of the ventral meningioma of the spinal canal. \u003cem\u003eNeurol Neurochir Pol \u003c/em\u003e2016; \u003cstrong\u003e50\u003c/strong\u003e(3)\u003cstrong\u003e: \u003c/strong\u003e226-30.\u003c/li\u003e\n\u003cli\u003eYoshii T, Egawa S, Hirai T, Kaito T, Mori K, Koda M\u003cem\u003e et al.\u003c/em\u003e A systematic review and meta-analysis comparing anterior decompression with fusion and posterior laminoplasty for cervical ossification of the posterior longitudinal ligament. \u003cem\u003eJ Orthop Sci \u003c/em\u003e2020; \u003cstrong\u003e25\u003c/strong\u003e(1)\u003cstrong\u003e: \u003c/strong\u003e58-65.\u003c/li\u003e\n\u003cli\u003eYoshii T, Egawa S, Chikuda H, Wakao N, Furuya T, Kanchiku T\u003cem\u003e et al.\u003c/em\u003e Comparison of anterior decompression with fusion and posterior decompression with fusion for cervical spondylotic myelopathy-A systematic review and meta-analysis. \u003cem\u003eJ Orthop Sci \u003c/em\u003e2020; \u003cstrong\u003e25\u003c/strong\u003e(6)\u003cstrong\u003e: \u003c/strong\u003e938-945.\u003c/li\u003e\n\u003cli\u003eAboul-Enein HA, Khidr WM, Abdeen KM, Madawi AA. Surgical management of ventrally based lower cervical (subaxial) meningiomas through the lateral approach: Report on 16 cases. \u003cem\u003eClin Neurol Neurosurg \u003c/em\u003e2015; \u003cstrong\u003e139: \u003c/strong\u003e152-8.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1 Demographics and imaging findings\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"545\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003eVentral (n=17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003eDorsolateral (n=22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e59.4 \u0026plusmn; 3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e54.0 \u0026plusmn; 2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eGender (% male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e41.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eLocation (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;C1-2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;C3-4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;C5-7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003cp\u003e47.1\u003c/p\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003cp\u003e59.1\u003c/p\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003ePreoperative JOA score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e12.0 \u0026plusmn; 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e12.5 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eJOA: Japanese Orthopedic Association.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Surgical information\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"625\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eVentral (n=17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDorsolateral (n=22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eOperative time (minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e265.9 \u0026plusmn; 24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e268.3 \u0026plusmn; 18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eBlood loss (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e139.7 \u0026plusmn;42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e141.1 \u0026plusmn; 27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eNerve root resection (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e41.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eSimpson grade (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;I\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;II\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;III\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52.9\u003c/p\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e63.6\u003c/p\u003e\n \u003cp\u003e36.4\u003c/p\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003ePerioperative complications (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e41.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eLength of hospital stay (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e29.5 \u0026plusmn; 3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e25.1 \u0026plusmn; 2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eJOA: Japanese Orthopedic Association.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Details of the cases requiring nerve root resection\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"654\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eCase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eLocation of the tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eLevel of transected nerve root\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 296px;\"\u003e\n \u003cp\u003eSymptoms following nerve root transection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eVentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eC7 (dorsal and ventral roots)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 296px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eVentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003eC3 (dorsal root)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 296px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eVentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eC5 (dorsal and ventral roots)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 296px;\"\u003e\n \u003cp\u003eTemporary paralysis of the deltoid muscle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eVentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eC5 (dorsal root)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 296px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eVentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eC4 (dorsal and ventral roots)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 296px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eVentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eC5 (dorsal and ventral roots)\u003c/p\u003e\n \u003cp\u003eC6 (dorsal root)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 296px;\"\u003e\n \u003cp\u003ePermanent paralysis of the deltoid muscle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eVentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eC2 (dorsal and ventral roots)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 296px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eDorsolateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eC3 (dorsal and ventral roots)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 296px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eDorsolateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eC4 (dorsal root)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 296px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Clinical outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"625\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eVentral (n=17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDorsolateral (n=22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003ePostoperative JOA score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e14.6 \u0026plusmn; 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e16.4 \u0026plusmn; 0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eRecovery rate of JOA score (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e35.2 \u0026plusmn; 23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e76.5 \u0026plusmn; 7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eTumor recurrence (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eFollow-up period (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e57.1 \u0026plusmn; 8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e60.6 \u0026plusmn;7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eJOA: Japanese Orthopedic Association.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"spinal-cord","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"sc","sideBox":"Learn more about [Spinal Cord](http://www.nature.com/sc/)","snPcode":"41393","submissionUrl":"https://mts-sc.nature.com/cgi-bin/main.plex","title":"Spinal Cord","twitterHandle":"@journalsci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6222599/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6222599/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e: Retrospective cohort study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e: Ventrally located cervical spinal meningiomas present significant surgical challenges due to their proximity to the spinal cord and nerve roots. This study aimed to evaluate the surgical outcomes of these tumors resected via the posterior approach and to compare them with dorsolaterally located meningiomas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e: The single institution in Japan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A retrospective review was conducted on 39 patients who underwent posterior surgical resection of cervical spinal meningiomas between 2008 and 2023, with a minimum follow-up of one year. Patients were classified into ventral (n = 17) and dorsolateral (n = 22) groups based on tumor localization. Neurological function was assessed using the Japanese Orthopedic Association (JOA) score, and surgical outcomes were compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The groups had no significant differences in operative time or blood loss. However, nerve root resection was significantly more frequent in the ventral group (41.2% vs. 9.1%, p = 0.02), and perioperative complications were more common (41.2% vs. 13.6%, p = 0.06). Although postoperative JOA scores were lower in the ventral group (14.6 ± 0.6 vs. 16.4 ± 0.3, p = 0.01), both groups showed significant postoperative improvement compared to preoperative scores (p \u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Despite the higher risk of nerve root sacrifice and limited neurological recovery associated with the posterior approach, considering the functional improvements from baseline, it remains a viable surgical option for ventrally located cervical meningiomas. Further studies comparing different surgical approaches are needed to optimize treatment strategies.\u003c/p\u003e","manuscriptTitle":"Surgical Outcomes of Ventrally Located Cervical Spinal Meningiomas","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-27 09:59:57","doi":"10.21203/rs.3.rs-6222599/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2025-04-29T15:34:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-04-10T21:44:14+00:00","index":1,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-04-01T19:02:46+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-03-20T20:02:26+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-03-19T12:34:31+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-03-18T17:05:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-17T17:10:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Spinal Cord","date":"2025-03-15T05:15:52+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2025-03-14T15:54:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-13T21:11:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"spinal-cord","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"sc","sideBox":"Learn more about [Spinal Cord](http://www.nature.com/sc/)","snPcode":"41393","submissionUrl":"https://mts-sc.nature.com/cgi-bin/main.plex","title":"Spinal Cord","twitterHandle":"@journalsci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9574c2fd-067a-481a-adc2-fcaec2e3902d","owner":[],"postedDate":"March 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":45865878,"name":"Health sciences/Medical research/Outcomes research"},{"id":45865879,"name":"Health sciences/Neurology/Neurological disorders/Spinal cord diseases"}],"tags":[],"updatedAt":"2025-09-25T07:17:10+00:00","versionOfRecord":{"articleIdentity":"rs-6222599","link":"https://doi.org/10.1038/s41393-025-01118-5","journal":{"identity":"spinal-cord","isVorOnly":false,"title":"Spinal Cord"},"publishedOn":"2025-09-24 04:00:00","publishedOnDateReadable":"September 24th, 2025"},"versionCreatedAt":"2025-03-27 09:59:57","video":"","vorDoi":"10.1038/s41393-025-01118-5","vorDoiUrl":"https://doi.org/10.1038/s41393-025-01118-5","workflowStages":[]},"version":"v1","identity":"rs-6222599","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6222599","identity":"rs-6222599","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}