This article ^{Reference Sonfack1} presents a well-structured contribution to the growing body of literature on minimally invasive surgery (MIS) for cervical meningiomas. By combining a systematic review with a retrospective case series, the authors provide both a broad and focused perspective on the safety and efficacy of MIS techniques in this context.

A major strength of the study lies in its rigorous methodology. The systematic review adheres to PRISMA guidelines and includes a detailed risk of bias assessment using Joanna Briggs Institute tools, enhancing the credibility of its findings. The inclusion of tumor occupation ratios and the identification of a potential surgical threshold predictive of neurologic deterioration (77%) represent a clinically relevant insight that may inform surgical decision-making, consistent with albeit higher than prior reports of spinal meningiomas in an open surgical context. ^{Reference Yamaguchi2}

The case series reinforces the review’s conclusions, demonstrating consistent gross total resection (Simpson grade 2), minimal postoperative complications and favorable neurological outcomes with MIS tubular resection. The authors’ emphasis on patient selection criteria – tumor size ≤ 3 cm and involvement of ≤ 2 cervical levels – adds practical value for clinicians considering MIS approaches.

However, there are limitations to this study. Sample sizes are small (15 patients in the review, 8 in the case series), with limited generalizability from a retrospective series. The lack of a control group undergoing open surgery precludes direct comparison of outcomes, including surgical time and associated pain scores. While the authors acknowledge these limitations and propose a multicenter prospective study, the current evidence remains preliminary. As this remains a relatively rare pathology, the primary goal of manuscripts such as this is to highlight the safety and technical feasibility of MIS approaches for surgeons wishing to incorporate them into their armamentarium.