Unilateral biportal endoscopy for thoracic intradural meningioma: a two-case technical report and narrative discussion.

BACKGROUND

Thoracic intradural extramedullary tumors, particularly meningiomas, are traditionally treated through open microsurgical approaches, which may be associated with extensive muscle dissection, postoperative pain, and longer recovery times. Recent advances in spinal endoscopy have expanded minimally invasive options for intradural pathology. Although uniportal endoscopic techniques have been described, their application remains limited by restricted instrument maneuverability and ergonomic constraints. Unilateral biportal endoscopy (UBE) has emerged as a promising alternative, offering independent visualization and working portals with enhanced illumination, magnification, and surgical precision. However, evidence regarding its use for thoracic intradural extramedullary tumors remains limited.

CASE DESCRIPTION: We report two patients with thoracic intradural extramedullary meningiomas who underwent tumor resection using a unilateral biportal endoscopic approach. Both patients presented with progressive thoracic myelopathy. Preoperative magnetic resonance imaging demonstrated well-defined intradural extramedullary lesions causing spinal cord compression. Surgery was performed under general anesthesia with the patient in the prone position. A left-sided paramedian biportal approach was used, consisting of a working portal and an endoscopic viewing portal. Hemilaminotomy was performed with preservation of the spinous process and facet joint, followed by durotomy, complete tumor resection, and watertight dural closure under endoscopic visualization. Histopathological examination confirmed World Health Organization (WHO) grade I meningioma in both cases. No intraoperative or postoperative complications occurred. Both patients experienced significant neurological improvement during follow-up, with radiological confirmation of complete tumor resection and adequate spinal canal decompression. Hospital stay was less than 10 days in both cases.

CONCLUSIONS

UBE is a safe and effective minimally invasive alternative for the resection of thoracic intradural extramedullary meningiomas. This technique allows adequate decompression, precise tumor resection, and preservation of posterior spinal elements, with favorable clinical and radiological outcomes. UBE may represent a valuable addition to the surgical armamentarium for selected intradural spinal tumors.