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Fukui K, Tsuji O, Suzuki S, Nori S, Nagoshi N, Okada E, Yagi M, Okita H, Fujita N, Watanabe K, Nakamura M, Matsumoto M. A rare case of dumbbell-shaped lymphoplasmacyte-rich meningioma arising at the upper cervical spinal cord. J Orthop Sci 2023; 28:1439-1444. [PMID: 34030941 DOI: 10.1016/j.jos.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Kenichiro Fukui
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Okita
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Gader G, Masmoudi M, Ghedira K, Krifa MI, Chelly I, Zammel I, Badri M. Lumbar spine epidural meningioma: report of a rare case. Spinal Cord Ser Cases 2023; 9:53. [PMID: 37907495 PMCID: PMC10618258 DOI: 10.1038/s41394-023-00608-z] [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: 11/04/2022] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Spinal meningiomas are typically intradural lesions. Some may infiltrate the dura mater, thus exhibit direct extradural extension. Pure spinal epidural meningiomas are very rare. Here we present a 64 year-old-male with a purely extradural meningioma, and reviewed 15 previously reported cases from the literature. CASE PRESENTATION AND CLINICAL DISCUSSION A 64-year-old male presented with a progressive cauda equine syndrome. When Lumbar spine MRI showed two extradural lesions regarding the L3-L4 level, one was fully removed (i.e., the posterolateral lesion), while the other anterior lesion was left alone (i.e., to avoid potential neurologic sequelae). Pathologically, the lesion was a benign meningioma. CONCLUSIONS Spinal epidural meningiomas are rare and should optimally be fully excised at the index surgery.
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Affiliation(s)
- Ghassen Gader
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia.
| | - Mourad Masmoudi
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Khalil Ghedira
- Department of Neurosurgery, National Institute of Neurology, Tunis, Tunisia
| | | | - Ines Chelly
- Department of Pathology, La Rabta Hospital, Tunis, Tunisia
| | - Ihsèn Zammel
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
| | - Mohamed Badri
- Department of Neurosurgery, Trauma and Burns Center, Ben Arous, Tunisia
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3
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di Bonaventura R, Caccavella VM, Latour K, Rapisarda A, Gessi M, Montano N, Visocchi M, Olivi A, Polli FM. Spinal Epidural Atypical Meningioma: Case Report and Review of the Literature. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:369-373. [PMID: 38153495 DOI: 10.1007/978-3-031-36084-8_56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Spinal atypical meningiomas are rare, and those whose main extension is in the epidural space are anecdotal. Here, we report a case of a young woman presenting with sensory disturbances and a radiological diagnosis of a dorsal epidural sleeve-like mass. The surgical resection of the lesion allowed the decompression of the spinal cord and led to the histopathological diagnosis of atypical meningioma. At the 3-month follow-up, her neurological recovery was complete. Because of the gross total removal of the lesion, adjuvant radiotherapy was not performed: At the 2-year follow-up, no recurrence of disease was detected. A comprehensive literature review was performed, and just two more case reports on epidural atypical meningiomas were found in the English literature. Through this case report and literature review, we described a rare manifestation of spinal meningioma that entered into a differential diagnosis for extradural spinal lesions, such as secondary malignancies.
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Affiliation(s)
- Rina di Bonaventura
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Valerio Mario Caccavella
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Kristy Latour
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Gessi
- Institute of Pathologic Anatomy, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Visocchi
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
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4
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Wang ZL, Mou JH, Sun D, Liu P. Case Report: Upper Thoracic Purely Extradural Spinal Meningioma With Nerve Root Attachment: A Case Report and Literature Review. Front Surg 2022; 9:918094. [PMID: 35784918 PMCID: PMC9243507 DOI: 10.3389/fsurg.2022.918094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction We describe a case of purely extradural spinal meningioma (EDSMs) with nerve root attachment and present the clinical profiles, radiological findings, operative management, and follow-up data, along with a literature review. This case study is purely extradural spinal meningioma attached to the nerve root, and the available literature review discusses the diagnosis and treatment. Purely epidural spinal meningiomas are extremely rare, and only a few clinical reports are published on this disease. Although epidural meningioma is a benign tumor, the recurrence rate is higher when compared with ordinary meningioma. Case study A 39-year-old male complained of chest and back pain with ring-shaped radiations to the precordial area and numbness in both the lower extremities. After a long walk, he felt disharmony in both his lower limbs. Magnetic resonance imaging showed a mass located on the left posterolateral side of the T1–T3 spinal cord and exhibited a dumbbell-type growth outward at the level of the T2–T3 intervertebral foramen. On the left side of the thoracic, a hemilaminectomy procedure was performed. The tumor was found in the ventral side of the left nerve root of T1 and was surrounded by the left nerve root of T2. To obliterate the tumor, the T2 nerve root was severed. The patient was advised to come for the follow-up on the 3rd, 6th, and 12th months postoperatively, and there were no complaints or signs of recurrence. Conclusion Purely extradural spinal meningioma with nerve root attachment is rare and has no clinical symptoms and image findings. To completely resect the lesion and avoid recurrence, the affected nerve root, epidural fat tissue, and nerve root sheath should be extensively resected and burned, coagulating the adjacent ventral posterior longitudinal ligament.
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Maki Y, Abekura Y, Kawasaki T, Kobayashi T, Ioroi Y, Takayama M. Embolization of a vertebral artery encased in a regrowth cervical meningioma before resection. Surg Neurol Int 2022; 13:180. [PMID: 35509541 PMCID: PMC9063020 DOI: 10.25259/sni_300_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Managing intraoperative bleeding may be challenging when a cervical tumor encases the vertebral artery (VA). Here, a patient with a recurrent cervical meningioma between the C1/2 and C3/4 levels and encasement of the right VA injury developed intraoperative bleeding that was endovascularly embolized postoperatively.
Case Description:
A 30-year-old female presented with a progressive quadriparesis, most markedly involving the right upper extremity. Six years ago, she had a cervical meningioma resected at the C2/3 level. The new MR revealed regrowth of intraspinal tumor between the C1/2 to C4/5 levels accompanied by extradural encasement of the right VA within the C2/3 and C3/4 foramina. Before the first surgery, the right VA was embolized (i.e., after a balloon occlusion test proved negative). During the attempted resection of the intradural/extradural tumor, bleeding from the right VA was encountered; it was temporarily controlled. After complete occlusion of the right VA was angiographically confirmed, a second-stage procedure to fully resect the extradural remanent of the tumor was undertaken.
Conclusion:
Endovascular embolization of the right VA before the attempted resection of a recurrent intraspinal/extraspinal cervical meningioma failed to occlude the vessel entirely. The VA bleeding encountered intraoperatively was temporarily controlled. Delayed total VA occlusion was angiographically observed before full tumor resection could be completed.
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Affiliation(s)
- Yoshinori Maki
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone,
| | - Yu Abekura
- Department of Neurosurgery, Otsu City Hospital, Otsu, Shiga, Japan
| | | | - Tamaki Kobayashi
- Department of Neurosurgery, Otsu City Hospital, Otsu, Shiga, Japan
| | - Yoshihiko Ioroi
- Department of Neurosurgery, Otsu City Hospital, Otsu, Shiga, Japan
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6
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Shui C, Turchini J, Davies M. Purely extradural spinal meningioma: A case report and literature review. Surg Neurol Int 2021; 12:431. [PMID: 34513194 PMCID: PMC8422538 DOI: 10.25259/sni_653_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Purely extradural spinal meningiomas (ESMs) are exceptionally rare and are often incorrectly diagnosed as metastases, hematological malignancies, or schwannomas. Here, we report a 66-year-old female who presented with an isolated extradural ESM. Case Description: A 66-year-old female presented with a 2.5-year history of a progressive paraparesis (i.e. T7 level) associated with a T5 sensory level. The MR showed a heterogeneously enhancing lesion circumferentially involving the spinal cord from T3 to T5, with left-sided T4/5 foraminal extension. Following a Simpson Grade 2 resection, the patient rapidly recovered full neurological function. Conclusion: The vast majority of the rarely encountered purely ESM are benign. Although gross total resection is optimal, additional adjunctive treatments are available for those treated with subtotal resections.
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Affiliation(s)
- Cher Shui
- Department of Neurosurgery, St George Hospital, Kogarah, New South Wales, 2217, Australia.,Conjoint Associate Lecturer, St George Hospital and Sutherland Clinical School, UNSW Medicine, Australia
| | - John Turchini
- Histopathology Department, Douglass Hanly Moir Pathology (Sonic Healthcare), Macquarie Park, NSW, 2113, Australia.,Discipline of Pathology, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, 2109, Australia.,Sydney Medical School, The University of Sydney, Sydney, 2006, Australia.,Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia
| | - Mark Davies
- Department of Neurosurgery, St George Hospital, Kogarah, New South Wales, 2217, Australia.,Conjoint Associate Professor, St George and Sutherland Clinical School, UNSW Medicine, Australia
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Spinal Clear Cell Meningioma: Atypical Clinical and Radiological Manifestations. Case Rep Surg 2021; 2021:9998399. [PMID: 34136303 PMCID: PMC8175162 DOI: 10.1155/2021/9998399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/03/2021] [Indexed: 11/18/2022] Open
Abstract
Meningioma has many subtypes with clear cell meningioma being more aggressive than other variants of meningioma and one of the rarest. We report a case of spinal clear cell meningioma that occurred in a 25-year-old lady who presented with the inability to be in the supine position. A magnetic resonance image showed an intradural mass extending from L1 to L4. Near complete excision was done. The patient had motor weakness postoperatively which improved gradually. A histopathological study showed a clear cell meningioma. In a differential diagnosis of any space-occupying lesion of the spine, clear cell meningioma should be considered though it is a rare form of meningioma due to its potential to recure. An accurate follow-up is warranted.
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8
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Hersh EH, Sarkiss CA, Ladner TR, Lee N, Kothari P, Lakomkin N, Caridi JM. Perioperative Risk Factors for Thirty-Day Morbidity and Mortality in the Resection of Extradural Thoracic Spine Tumors. World Neurosurg 2018; 120:e950-e956. [DOI: 10.1016/j.wneu.2018.08.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
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9
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Frati A, Pesce A, Toccaceli G, Fraschetti F, Caruso R, Raco A. Spinal Meningiomas Prognostic Evaluation Score (SPES): predicting the neurological outcomes in spinal meningioma surgery. Neurosurg Rev 2018. [PMID: 29516306 DOI: 10.1007/s10143-018-0961-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Among many factors leading to a worse functional prognosis in spinal meningioma (SM) surgery, in a previous study, we recognized anterior/anterolateral axial topography, sphincter involvement at first evaluation, surgery performed on a recurrence, and worse preoperative functional status. The purpose of this paper is to evaluate the cumulative weight of these factors on prognosis through a multinomial logistic regression model performed on an original evaluation scale designed by the authors on the ground of the experience of the neurosurgical departments of our University. The original SM database composed of 173 cases was classified in regard to sex, age, symptoms, axial and sagittal location, Simpson grade resection, and functional pre/postoperative status. Fine presurgical and follow-up reevaluations were available. The authors propose a scale (Spinal Meningiomas Prognostic Evaluation Score (SPES)) of preoperative evaluation to assess the surgery-related risk of neurological worsening experienced by the patients included in the present cohort. The authors describe a strong statistical association between the SPES and the follow-up Frankel and McCormick scores (r = - 460 and .441, p .001, both). Through a univariate ANOVA analysis, we disclosed that patients presenting scores 2 and 3 had a significantly higher association to lesser Frankel and McCormick postoperative scores, in respect to patients presenting SPES scores 0-1 (univariate ANOVA, p .008 and .011). Anterior or anterolateral axial location, operating on a recurrence of SM, sphincter involvement, and worse functional grade at onset present, along with the SPES scores are fairly predictive and reliable in respect to the long-term results of patients suffering from SM.
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Affiliation(s)
- Alessandro Frati
- IRCCS "Neuromed" Neurosurgery Department, Sapienza University, Rome, Italy
| | - Alessandro Pesce
- NESMOS Department Neurosurgery Department, Sapienza University, Rome, Italy. .,Azienda Universitario-Ospedaliera Sant'Andrea, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
| | - Giada Toccaceli
- NESMOS Department Neurosurgery Department, Sapienza University, Rome, Italy.,Azienda Universitario-Ospedaliera Sant'Andrea, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Flavia Fraschetti
- NESMOS Department Neurosurgery Department, Sapienza University, Rome, Italy.,Azienda Universitario-Ospedaliera Sant'Andrea, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Riccardo Caruso
- Neurosurgery Division of "Neurology and Psychiatry" Department, Sapienza University, Rome, Italy
| | - Antonino Raco
- NESMOS Department Neurosurgery Department, Sapienza University, Rome, Italy.,Azienda Universitario-Ospedaliera Sant'Andrea, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
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Pant I, Gautam VKS, Kumari R, Chaturvedi S. Spinal tumour: primary cervical extradural meningioma at an unusual location. JOURNAL OF SPINE SURGERY 2017; 3:509-513. [PMID: 29057366 DOI: 10.21037/jss.2017.08.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extradural spinal meningiomas are extremely rare, more so in the cervical region. A purely extradural location as reported in this paper is quite exceptional. The authors report a case of extradural meningioma in a 50-year-old male located in the cervical spine that was surgically treated with the provisional diagnosis of a neurofibroma. Histopathological diagnosis of meningothelial meningioma was made with the routine hematoxylin and eosin (HE) stain. The origin, clinical course, radiological features, pathological findings with the differential diagnosis and surgical treatment are discussed based on a review of the literature. An extradural spinal meningioma, an extremely rare entity, is still a diagnostic dilemma on radiology as the radiologic findings overlap with many other common extradural spinal masses.
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Affiliation(s)
- Ishita Pant
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, Delhi, India
| | | | - Rima Kumari
- Department of Neuroradiology, Institute of Human Behaviour and Allied Sciences, Delhi, India
| | - Sujata Chaturvedi
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, Delhi, India
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11
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Zhang LH, Yuan HS. Imaging Appearances and Pathologic Characteristics of Spinal Epidural Meningioma. AJNR Am J Neuroradiol 2017; 39:199-204. [PMID: 29051204 DOI: 10.3174/ajnr.a5414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/29/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spinal epidural meningioma is an uncommon tumor. This study aimed to analyze the imaging and pathologic characteristics of this rare tumor. MATERIALS AND METHODS Fourteen confirmed cases of epidural meningioma were retrospectively reviewed, and imaging characteristics and pathologic findings were analyzed to identify the typical features. RESULTS The mean age of the patients (4 men, 10 women) was 44.9 years. Twelve tumors were in the cervical spinal canal, and 2, in the thoracic spinal canal. There were 9 en plaque meningiomas, 4 dumbbell-shaped meningiomas, and 1 fusiform/ovoid meningioma. The epidural meningiomas extended over 2-5 spinal segments (mean, 3.2 spinal segments). A soft epidural mass was seen in 12/14 (86%) patients. Dural calcification was seen in 8/14 (57%) tumors. Tumor caused intervertebral foramen enlargement in 10/14 (71%) patients and adhered to the nerve roots in 11/14 (79%) patients. Intradural invasion was seen in 8/14 (57%) patients. The dural tail sign was present in 13/14 (93%) tumors on contrast-enhanced T1WI. Regarding pathologic type, 10 of 14 (71%) were psammomatous, 2 of 14 (14%) were meningothelial, 1 of 14 (7%) was angiomatous, and 1 of 14 (7%) was transitional. During follow-up (mean follow-up, 73.4 months; range, 4-192 months), 7 patients had recurrence. Recurrences were between 4 and 192 months after the operation. CONCLUSIONS Epidural meningioma has 3 different growth patterns. Dural thickening, calcification, invasion, and epidural mass formation are characteristic features of epidural meningioma. Regular follow-up imaging is required to detect recurrence.
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Affiliation(s)
- L H Zhang
- From the Department of Radiology, Peking University Third Hospital, Beijing, People's Republic of China
| | - H S Yuan
- From the Department of Radiology, Peking University Third Hospital, Beijing, People's Republic of China.
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Leon-Ariza DS, Campero A, Romero Chaparro RJ, Prada DG, Vargas Grau G, Rhoton AL. Key Aspects in Foramen Magnum Meningiomas: From Old Neuroanatomical Conceptions to Current Far Lateral Neurosurgical Intervention. World Neurosurg 2017; 106:477-483. [DOI: 10.1016/j.wneu.2017.07.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 11/29/2022]
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