A rare case of concomitant cervical disc herniation and intradural meningioma treated with one-stage posterior surgery

Surgical management of de novo metastatic meningioma of the spine: An underestimated issue for WHO grade II/III meningiomas

OBJECTIVES

Meningioma is a slow-growing neoplasm derived from meningothelial cells. Extradural metastasis of WHO grade II/III meningiomas is relatively rare, and spinal metastatic meningiomas (SMM) have only been described in individual case reports. The aim of the present study is to discuss the clinical features and treatments of SMM patients.

METHODS

Fourteen SMM patients who received surgery in our center between 2010 and 2020 were reviewed retrospectively. Possible prognostic factors affecting local progression-free survival (LPFS) and overall survival (OS) were analyzed by log-rank analysis.

RESULTS

Our series comprised nine men and five women, with a median age of 49 years. The interval from the primary treatment to SMM varied from 1 to 11 years. Lesions were mainly located in the lumbar-sacral region (7/14, 50.0%), followed by the thoracic spine (5/14, 35.7%) and cervical (2/14, 14.3%) spine. The median follow-up period was 42.7 months, during which six patients (42.9%) passed away. Local tumor progression was detected in four patients (28.6%). Log-rank analysis indicated that circumferential surgery was associated with good LPFS, whereas WHO grade III and visceral metastasis were factors adversely affecting OS.

CONCLUSIONS

SMM is a challenging clinical entity, usually occurring in the fourth to fifth decades of life. Circumferential surgery is associated with good LPFS. WHO grade III and visceral metastasis are factors adversely affecting OS of patients with SMM. Long-term follow-up is recommended for patients who have received surgical treatment for primary meningiomas (Simpson Grade III/IV), especially for WHO III lesions.

Neurological impairment in a patient with concurrent cervical disc herniation and POEMS syndrome

PURPOSE

POEMS syndrome is a rare clonal plasma cell disease characterized by polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes. We report a rare case of neurological impairment in patients with concurrent cervical disc herniation and POEMS syndrome.

METHODS

A patient presented to a local hospital with C3/4 and C4/5 disc herniation, apparent spinal cord compression concomitant with neurological signs, and concurrent POEMS syndrome. Anterior cervical discectomy and fusion was performed.

RESULTS

The limb numbness was only slightly alleviated, and 10 days postoperatively the patient complained of muscle weakness of the extremities and was referred to our hospital. The patients exhibited non-typical neurological signs and an enlarged liver and spleen that could not be explained. Electroneuromyography and immunofixation electrophoresis produced abnormal results. We diagnosed concurrent POEMS syndrome, for which drug therapy was prescribed. The patient's symptoms receded.

CONCLUSION

Patients presenting with cervical spondylopathy and non-typical neurological signs and symptoms or other systemic problems should be evaluated for the presence of concurrent disease and ruled out differential diagnoses.