Posterior Paramedian Approach to a Ventrally Located Spinal Meningioma

Abstract Background To approach a ventral spinal pathology, a lateral viewing angle is often required. However, lateral approaches to the spine are usually more technically demanding and require certain amount of surgical expertise. In this report, we describe a simple and easy technique to obtain the lateral viewing angle to the ventral spinal pathology. Case Description The technique is demonstrated in a ventrally located meningioma at C2 level. Axial magnetic resonance imaging (MRI) showed a square posterior shift of the spinal cord with little lateral space, which necessitated a more lateral viewing angle than the conventional posterior approach. With the patient in a prone position, we made a horizontal skin incision at the level of C2 and unilaterally exposed the right side of the C1 and C2 laminae. We then made a small perpendicular incision on the medial portion of the paravertebral muscles, which we retracted longitudinally. This approach provided an unobstructed lateral view toward the spinal cord. Following a gross total removal of the tumor with minimal cord retraction, the patient made an uneventful recovery. Her preoperative neurological symptoms completely resolved in two months. No significant muscle atrophy was observed on postoperative MRI at three months. There was no long-term complication related to the muscle incision at one-year follow-up. Conclusion The posterior paramedian approach is a simple and versatile technique to obtain lateral viewing angle to the spine and useful for approaching lesions residing ventral to the spinal cord.