Dura tumors

　　Dura tumors usually occur around the nerve roots near the dura, and the arachnoid cap cells can explain why dura tumors are often located on the side. Dura tumors can also originate from the fibroblasts of the pia mater or dura mater, suggesting that they may originate from mesodermal tissue.

　　Dura tumors originate from arachnoid endothelial cells or fibroblasts of the hard spinal cord, and are a benign spinal tumor. They mainly occur in women aged 40 to 70, and the incidence of dura tumors is much lower than that of meningiomas. So, what are the complications of dura tumors? The following experts introduce that complications may occur during the surgical treatment of dura tumors.

　　1. Epidural hematoma: Incomplete hemostasis of paravertebral muscles, vertebral bones, and venous plexuses of the dura mater can lead to hematoma formation after surgery, which can exacerbate limb paralysis. Hematomas often occur within 72 hours after surgery, even with the presence of drainage tubes. If this phenomenon occurs, it is important to actively explore, remove the hematoma, and achieve complete hemostasis.

　　2. Spinal cord edema: Often caused by spinal cord injury during surgery, clinical manifestations are similar to a hematoma. Treatment mainly includes dehydration and hormone therapy, and for severe cases, reoperation and opening of the dura mater may be required.

　　3. Cerebrospinal fluid leakage: Often caused by incomplete suturing of the dura mater and muscle layer, if there is drainage, the drainage tube should be removed in advance. For those with little leakage, medication and observation should be changed. For those with persistent or severe leakage, surgical repair of the fistula should be performed in the operating room.

　　4. Incision infection: Generally, incision dehiscence occurs in poor conditions, with poor wound healing ability or cerebrospinal fluid leakage. During surgery, attention should be paid to aseptic operation. After surgery, in addition to antibiotic treatment, it is important to actively improve the overall condition, especially the supplementation of protein and various vitamins.

　　Meningiomas grow slowly, unless intratumoral hemorrhage or cystic change occurs, causing a significant increase in volume in a short period of time. Clinically, it mainly manifests as chronic progressive symptoms of spinal cord compression, leading to motor, sensory, reflex, sphincter function, and skin nutritional disorders below the compressed level. Due to the compensatory mechanism of the spinal cord, symptoms may be fluctuating, but the overall trend is gradual deterioration.

　　The early symptoms of meningioma are not characteristic and not prominent, mostly discomfort in the corresponding area, and (or) non-continuous mild pain, which is not enough to attract attention. Even if medical treatment is sought, it may be misdiagnosed as pleurisy, angina, cholecystitis, and other internal diseases, or arthritis, radiculitis, osteoarthritis, lumbar muscle strain, sciatica, and other conditions. General symptomatic treatment can alleviate the symptoms, thus delaying treatment.

　　The prognosis of meningioma depends on the nature of the tumor, the site of growth, the degree of spinal cord compression, the duration, and the general condition of the patient. Generally, the higher the segment of the tumor, the greater the range of neurological dysfunction, and the poorer the prognosis. It is important to actively prevent muscle dysfunction, urinary retention, urinary tract infections, and good prognosis for those with well-differentiated tumors and small atypia. Conversely, poor prognosis is associated with poorly differentiated tumors and large atypia. Prevention of spinal cord compression is closely related to the duration of compression and the degree of dysfunction. The sooner the treatment is started, the better the outcome, and vice versa.

　　The meningeal tumor appears as a solid mass on CT scans, with a density slightly higher than that of normal spinal cord. The tumor is often circular or elliptical, and calcification within the tumor is a significant feature. Cystography CT shows widening of the subarachnoid space at the tumor site, compression of the spinal cord to the opposite side, and narrowing or disappearance of the subarachnoid space on the opposite side. MRI shows that meningeal tumors are superior to CT, as it can reveal the presence of soft tissue masses behind the thoracic cord or in front of the cervical cord, with the spinal cord displaced to the opposite side. The spinal cord may be compressed, flattened, or deformed. The mass appears circular or elliptical in the transverse section, while the vertical and coronal sections often show a longer diameter than the transverse diameter, presenting as rectangular, elongated, or long strip-like shapes.

　　Patients with dura mater tumors should eat fresh, easily digestible foods rich in high-quality protein, vitamins, and minerals, with fresh vegetables and fruits essential at every meal. It is necessary to eat more foods with anti-cancer and anti-tumor properties, such as cauliflower, cabbage, broccoli, asparagus, legumes, mushroom, sea cucumber, and flatfish.

　　Patients with dura mater tumors should choose foods with the effects of softening hardness and dispersing nodules: sea cucumber, nori, wakame, sea urchin, abalone, cuttlefish, kelp, turtle, red bean, radish, rapeseed, grass, mushrooms, etc. These food properties are sticky and easy to harm the spleen and stomach, so less should be eaten when there is poor appetite and fever.

　　Dura mater tumors belong to benign spinal cord tumors, and surgical resection has good therapeutic effects. Some patients may have already developed transverse myelitis, but the function of the spinal cord may still recover after tumor resection. Compared with intracranial meningiomas, spinal meningiomas are less likely to have bony destruction, lack large venous sinuses and artery branches, and can be gently pulled away from the spinal cord to protect the spinal cord tissue. The epidural venous plexus is more abundant on the ventral side and expands with the growth of the ventral meningioma. It is often difficult to stop bleeding from these blood vessels during surgery. Lateral and dorsal spinal cord tumors can be removed by traction of the dura edge away from the spinal cord, and complete resection of the tumor can be obtained by removing the local dura at the origin of the tumor. For tumors located on the lateral and ventral sides, the arachnoid layer on the surface of the tumor should be incised to facilitate the separation of the poles of the tumor from the surface of the tumor. A few cotton pads should be placed around the tumor to reduce the entry of blood into the subarachnoid cavity, and then the exposed tumor surface should be electrocoagulated to reduce the blood vessels and volume of the tumor. For larger tumors, the central part of the tumor should be electrocoagulated and resected in pieces, and then the tumor sac wall adhering to the spinal cord should be carefully separated and resected. Finally, the dura base tumor should be resected, and the involved dura should be electrocauterized to achieve complete resection. The pericostal fascia should be used to repair the dura. The subarachnoid cavity should be flushed clean with warm normal saline to remove blood clots and necrotic tissue. For the arachnoid adhesions in the compressed and deformed spinal cord tissue, they can be relieved. These operations may help prevent postoperative complications such as spinal cord tethering, arachnoiditis, delayed formation of spinal cord cysts, and hydrocephalus. A few dura mater tumors grow out of the intervertebral foramen through the dural sheath of the nerve root, forming a dumbbell shape. The technique for resecting the tumor is the same as that for resecting neurilemmomas, and cutting the involved nerve root at this level rarely causes dysfunction. The treatment of the dural base is the most controversial in the treatment of meningiomas. Resection of the dural origin of the tumor and repair with the pericostal fascia, or expanding the electrocoagulation range in situ, are all effective methods in the treatment process.

　　During surgery, it should be noted that most meningiomas are closely connected to the spinal dura mater with a broad base, and operations can be performed under a microscope. First, the inner layer of the spinal dura mater along the base of the tumor should be stripped off, and if difficulties arise, the entire adherent spinal dura mater can be excised to reduce bleeding and tumor recurrence. Most meningiomas have abundant blood supply, and blood supply to the tumor should be blocked first during surgery to reduce bleeding. For tumors growing on the dorsal or lateral side of the spinal cord, after stripping the tumor base and blocking blood supply, the tumor volume decreases, becomes free, and then the adhesions around the tumor are separated to remove the tumor completely. For tumors located in the anterior or anterolateral part of the spinal cord, it is advisable not to attempt a complete resection, as this may cause excessive traction on the spinal cord and result in injury. Instead, a partial resection within the capsule should be performed first, and the capsule should be removed after the tumor volume decreases. To fully expose the surgical field, it may be necessary to cut 1-2 nerve roots and the dentate ligament.