The role of minimally invasive surgery (MIS) in spine surgery is evolving rapidly, owing to the benefits of improved patient outcomes. ^{Reference Ikwuegbuenyi, Inzerillo, Wang and Hussain1} Sonfack et al.’s case series and systematic review of cervical spine meningiomas resected through MIS techniques, highlighted a total of 23 patients with favorable postoperative clinical and oncologic outcomes. ^{Reference Sonfack, Brunette-Clément, Olijnyk, Gennari, Shédid and Yuh2}

The authors’ report of cervical meningioma resection through MIS techniques reflects an important advancement in the field. They showed that cervical meningioma can be safely resected in a select population with good outcomes. The key strengths of the authors’ work included a methodologically sound systematic review process and a comprehensive report of eight cases from their institution. They highlighted the tumor occupational ratio (a measure of spinal canal area occupied by the tumor) as a tool that may correlate with symptom onset – an insightful addition with the potential to inform future surgical decision making that warrants prospective validation.

However, the limitations inherent in small, retrospective case series and heterogeneity across studies in the systematic review should be acknowledged. Tumor size was inconsistently reported in the review, limiting granular analysis between lesion characteristics and surgical outcomes. The case series presented an average follow-up of 12.9 months with only one patient having follow-up past 2 years; long-term follow-up is imperative for establishing recurrence outcomes. Additionally, no patient-reported outcomes were reported, which are important measures that should be included in future studies. The study involved a highly selected group of 8 patients; future research should adopt a cohort design using consecutive cases with a prespecified entry criterion and a comparison group. The authors also described five criteria to guide patient selection for the use of the MIS technique for cervical meningioma. However, it would also be important to consider the level of expertise with MIS techniques of the surgeons involved. Given the steep learning curve in adopting tubular and endoscopic techniques for intradural extramedullary tumors, future work should clarify whether MIS techniques can lead to improved patient outcomes compared to open techniques.

Overall, this article provides a valuable reference for spine surgeons contemplating MIS for cervical meningiomas, reinforcing that with appropriate patient selection, MIS can achieve good outcomes with the potential added benefits of reduced morbidity and faster recovery. The authors should be commended for contributing data that will support further prospective studies needed to refine patient selection, expand indications safely and confirm long-term outcomes in this evolving field.