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Garufi G, Scalia G, Ricciardo G, Umana GE, Conti A, Cardali SM. Spinal Intramedullary Meningiomas: A Systematic Review with a Case Illustration. World Neurosurg 2024; 187:11-18. [PMID: 38548054 DOI: 10.1016/j.wneu.2024.03.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Intramedullary meningiomas are an exceptionally rare subtype of spinal tumors, accounting for only 5% of primary spinal neoplasms. Given their scarcity and unique characteristics, understanding optimal management approaches is crucial for improved clinical decision-making. This systematic review aims to consolidate existing literature and present a detailed case illustration to enhance understanding of this uncommon spinal tumor entity. METHODS A systematic search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Eligible studies included case reports, case series, cohort studies, reviews, and meta-analyses. Data extraction and synthesis focused on demographic characteristics, tumor location, clinical presentation, imaging findings, surgical interventions, histopathological features, and outcomes. RESULTS A total of 15 high-quality scientific articles were included in the systematic review, providing insights into various aspects of intramedullary meningiomas. Demographic analysis revealed a broad age distribution with an equal gender distribution among affected patients. Common clinical presentations included difficulty walking, sensory disturbances, spastic paraparesis, and urinary incontinence. Neuroimaging findings demonstrated heterogeneous signal intensity variations on T1- and T2-weighted images, with variable enhancement patterns on gadolinium-enhanced images. Surgical interventions, predominantly total resection, resulted in favorable postoperative outcomes in most cases. CONCLUSIONS Intramedullary meningiomas pose diagnostic and therapeutic challenges due to their rarity and unique characteristics. Tailored surgical approaches, incorporating techniques such as intraoperative neurophysiological monitoring and fluorescence-aided resection, are crucial for minimizing neurological deficits and optimizing patient outcomes. Despite their infrequency, recognizing intramedullary meningiomas in the differential diagnosis of spinal tumors is essential for prompt diagnosis and timely intervention, ultimately improving patient prognosis.
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Affiliation(s)
- Giada Garufi
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, Messina, Italy; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital, Catania, Italy
| | - Giuseppe Ricciardo
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, Messina, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie. (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Salvatore Massimiliano Cardali
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, Messina, Italy; Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, Messina, Italy
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Garufi G, Ricciardo G, Conti A, Cardali SM. Intramedullary sclerosing meningioma: operative video. NEUROSURGICAL FOCUS: VIDEO 2023; 9:V10. [PMID: 37854649 PMCID: PMC10581006 DOI: 10.3171/2023.7.focvid2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/14/2023] [Indexed: 10/20/2023]
Abstract
Sclerosing meningiomas (SMs) represent a rare histological variant of meningiomas, first described in 1989 as invasive bulking masses of whorling collagen bundles with a minimum percentage of meningothelia-resembling cells, and they are often misdiagnosed. The literature reports only 30 cases of SMs, with only two of them being intramedullary. The authors present the case of a patient with a cervical intramedullary SM who presented with gait disturbances, sensory deficits, weakness in four extremities, and hyperreflexia. The surgery was performed under neurophysiological monitoring and after administration of sodium fluorescein, which allowed us to discriminate the exact myelotomy point. Intramedullary SMs are very rare entities whose correct management may result in a good outcome.
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Affiliation(s)
- Giada Garufi
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, Italy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
| | - Giuseppe Ricciardo
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, Italy
| | - Alfredo Conti
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Alma Mater Studiorum Università di Bologna, Italy
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Yaltırık CK, Yamaner EO, Suakar Ö, Gürkan S, Sav A, Türe U. Whorling Sclerosing Ependymoma of the Cervical Spinal Cord Presenting Tanycytic Histopathologic Features: A Rare Case Report. Int J Surg Pathol 2023; 31:239-246. [PMID: 35611479 DOI: 10.1177/10668969221099629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tanycytic ependymoma is a neuroectodermal tumor that arises from ependymoglial cells or tanycytes. It is highly uncommon. We reported a 34-year-old man who was diagnosed with intradural-intramedullary tanycytic ependymoma, located at the level of C4-5 who had a 9-months history of neck pain and left arm pain, and numbness on fingers. One month prior to presentation, his left arm numbness and paresthesia deteriorated. The lesion was removed totally by C4, C5 hemilaminoplasty. The histologic pattern of this lesion was consisted of fascicles forming nebula-like whorling structures. Because of these structures, tanycytic ependymoma should be taken into consideration in the differential diagnosis of a whorling-sclerosing variant of meningiomas.
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Affiliation(s)
- Cumhur Kaan Yaltırık
- Department of Neurosurgery, Ümraniye Training And Research Hospital, Istanbul, Turkey
| | - Emin Oğuzcan Yamaner
- Department of Neurosurgery, 64172Yeditepe University School of Medicine, Istanbul, Turkey
| | - Öznur Suakar
- Department of Medical Genetics, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Sezin Gürkan
- Department of Medical Genetics, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Aydın Sav
- Department of Pathology, 64172Yeditepe University School of Medicine, Istanbul, Turkey
| | - Uğur Türe
- Department of Neurosurgery, 64172Yeditepe University School of Medicine, Istanbul, Turkey
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Alabbas Z, Tamer Y, Jneidi M, Issa R. Whorling‐sclerosing meningioma invading skull bone and subcutaneous tissue with an incidental toxoplasmosis: A case report. Neuropathology 2022. [DOI: 10.1111/neup.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Zeina Alabbas
- Department of Pathology Tishreen University Hospital Latakia Syria
| | - Yamani Tamer
- Department of Neurosurgery Tishreen University Hospital Latakia Syria
| | - Mhammad Jneidi
- Department of Radiology Tishreen University Hospital Latakia Syria
| | - Rana Issa
- Department of Pathology Tishreen University Hospital Latakia Syria
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Cheng C, Wang J, Zhao S, Tao B, Bai S, Shang A. Intramedullary Thoracic Meningioma: A Rare Case Report and Review of the Literature. World Neurosurg 2019; 129:176-180. [PMID: 31146040 DOI: 10.1016/j.wneu.2019.05.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Quite a few cases of intramedullary meningioma have been described in previously reported studies. We have presented a rare case of intramedullary thoracic meningioma, which was quite different from subdural extramedullary meningioma, and the preliminary diagnosis was mistakenly given as hemangioblastoma. CASE DESCRIPTION A 46-year-old man with complaints of gait problems and pain in the right lower extremity was admitted to our hospital. The neurological examination revealed 3 of 5 motor strength, spastic paraparesis, hyperreflexia, increased tone, and sensory deficits in the right lower extremity. Contrast-enhanced images showed a T6-T7 intramedullary lesion and an evident and homogeneously enhanced lesion with clearly defined borders on the sagittal, coronal, and axial views. The preliminary diagnosis was hemangioblastoma. However, he underwent tumor resection, and the histopathological examination findings confirmed the diagnosis of intramedullary meningioma. CONCLUSION Intramedullary thoracic meningiomas are extremely rare and differ from the common subdural extramedullary meningiomas. Clinicians should be aware of this when diagnosing intramedullary tumors. Gross total resection using a microsurgical technique will be the best treatment strategy.
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Affiliation(s)
- Cheng Cheng
- Department of Neurosurgery, Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jianzhen Wang
- Department of Neurosurgery, Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shuiqiang Zhao
- Department of Neurosurgery, Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Benzhang Tao
- Department of Neurosurgery, First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shaocong Bai
- Department of Neurosurgery, First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Aijia Shang
- Department of Neurosurgery, First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China.
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Cömert D, Tosuner Z, Hatiboglu MA. A rare case of sclerosing meningioma with immunohistochemical features. Br J Neurosurg 2019:1-2. [PMID: 30681002 DOI: 10.1080/02688697.2018.1556780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To identify histological types of Meningiomas', immunohistochemically markers are used. We present Phosphohistone-H3 (PHH-3) staining for the first time. The patient's case notes were retrospectively reviewed. PHH-3 staining revealed sparse mitotically active cells. PHH-3 staining can be used to grade sclerosing meningioma.
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Affiliation(s)
- Didem Cömert
- a Department of Neurosurgery , Bezmialem Vakıf University Medical School , Istanbul , Turkey
| | - Zeynep Tosuner
- b Department of Pathology , Bezmialem Vakıf University Medical School , Istanbul , Turkey
| | - Mustafa Aziz Hatiboglu
- a Department of Neurosurgery , Bezmialem Vakıf University Medical School , Istanbul , Turkey.,c Beykoz Institute of Life Sciences and Biotechnology , Bezmialem Vakif University , Istanbul , Turkey
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Whorling-Sclerosing Variant Meningioma of the Spine: Surgical Management and Outcome of an Extremely Rare Case. Spine (Phila Pa 1976) 2018; 43:E1422-E1425. [PMID: 29889797 DOI: 10.1097/brs.0000000000002733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report OBJECTIVE.: To report surgical resection of multiple ventral cervical and thoracic lesion being diagnosed as whorling-sclerosing variant meningioma (WSM) and subsequent stabilization of cervicothoracic spine. SUMMARY OF BACKGROUND DATA WSM is a rare histopathology variant of meningioma which is mostly reported in brain and only one case of cervical spine WSM has been reported. Because of the rarity of WSM, there is a paucity of information regarding the clinical, radiological, and histopathologic characteristics. METHODS A 57-year-old lady presented with progressive quadriparesis and myelopathy since 10 days. The spine magnetic resonance imaging (MRI) revealed multiple ventral cervical and thoracic lesions which were hypointense in T2-weighted images with heterogeneous and scant enhancement with gadolinium. The patient underwent anterior cervical corpectomy and gross total resection of the lesion along with 360° fixation in the first stage. The thoracic lesions were also resected totally through laminectomy and right lateral extracavitary approach followed by pedicular screw fixation. RESULTS The patient improved muscle powers and spasticity and is not independent (Frankel D). The histopathology examination revealed hypocellular lobulated sclerotic mass with whorling pattern of growth in the sclerotic part suggestive of WSM. Immunohistochemical evaluation demonstrated negative staining for epithelial membrane antigen, cytokeratin, Olig-2 and S-100 and immunoactivity for progesterone receptor (PR) and glial fibrillary acidic protein in the tumoral cells located at the periphery. Ki-67 indexing was low. CONCLUSION The spine multiple WSM is an extremely rare condition, which has a malignant behavior and it seems that it is spread by cerebrospinal fluid seeding. Surgical removal is hard and requires experience and appropriate equipment. LEVEL OF EVIDENCE 4.
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Elmaci İ, Altinoz MA, Sav A, Bolükbaşı FH, Önöz M, Başkan Ö, Sari R. Whorling-sclerosing meningioma. A review on the histological features of a rare tumor including an illustrative case. Clin Neurol Neurosurg 2017; 162:85-90. [DOI: 10.1016/j.clineuro.2017.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/15/2017] [Accepted: 09/25/2017] [Indexed: 11/30/2022]
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Piazza MA, Ramayya AG, Geiger GA, Alonso-Basanta M, Nasrallah MP, Welch WC, Ozturk AK. Intramedullary Recurrence of a Thoracic Meningioma-Presentation of an Unusual Case and Review of the Literature. World Neurosurg 2016; 92:588.e17-588.e21. [PMID: 26852709 DOI: 10.1016/j.wneu.2016.01.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/27/2016] [Accepted: 01/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spinal meningiomas are typically extra-axial, slow-growing, benign tumors that arise from the arachnoid cap cells. Intramedullary spinal meningiomas are exceedingly rare with few cases reported in the literature. CASE DESCRIPTION A 64-year-old man with a history of grade I thoracic meningioma at the T4 level resected initially in 1989 and who required reoperation in 2013 for intradural, extramedullary recurrence of tumor presented again in 2015 with gait difficulty. Magnetic resonance imaging revealed a soft tissue mass at the T3 to T4 levels on the left side of the canal that was mildly enhancing on T1 contrasted sequences. The patient was taken to the operating room, where a purely intramedullary recurrence was discovered without extramedullary extension or a dural-based attachment. The intramedullary tumor was completely resected, and postoperatively the patient recovered well and was at his neurologic baseline. The patient ultimately underwent proton beam radiotherapy because this tumor, although benign, had recurred twice. CONCLUSIONS Intramedullary spinal meningiomas, particularly intramedullary low-grade recurrence of a previously extramedullary tumor, are rare phenomena. Although the pathogenic mechanisms are not well understood, intramedullary recurrence as described in this patient may reflect extrinsic factors related to prior surgical resections in addition to histologic progression. When operating on recurrent extramedullary lesions, aggressive arachnoid dissection may predispose patients to unusual patterns of recurrence.
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Affiliation(s)
- Matthew A Piazza
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Ashwin G Ramayya
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Geoffrey A Geiger
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - MacLean P Nasrallah
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William C Welch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali K Ozturk
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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