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Hsieh PC, Lu JCY, Huang SC, Toh CH, Kuo HC. Unusual clinical presentation of cervical extradural meningioma detected with neuromuscular ultrasound: A case report. Exp Ther Med 2024; 27:205. [PMID: 38590559 PMCID: PMC11000052 DOI: 10.3892/etm.2024.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/12/2024] [Indexed: 04/10/2024] Open
Abstract
Extradural meningiomas are rare in the cervical region. A total of 70-77% of reported cases have occurred in the thoracic region. Tumors that occur in the cervical region may invade the adjacent nerve root and brachial plexus. Typically, diagnoses of extradural meningioma are made after patients present with signs of myelopathy, such as progressive paresis and numbness. In the current study, a 64-year-old male patient presented with neck pain, numbness and mild weakness in the left hand over a 6-month period. The general neurological examination was unremarkable, except for mild grasping weakness on the left side. Needle electromyography revealed complex repetitive discharges in the left 5 and 6th cervical paraspinal muscles. Neuromuscular ultrasound revealed a lesion over the left 7th cervical root, which enabled the early detection of an extradural meningioma before notable focal neurological defects developed. The patient underwent a subtotal tumor excision, followed by radiotherapy for residual tumor. Histopathological examination confirmed atypical meningioma.
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Affiliation(s)
- Pei-Chen Hsieh
- Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan, R.O.C
| | - Johnny Chuieng-Yi Lu
- Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan, R.O.C
| | - Shih-Chiang Huang
- Department of Anatomical Pathology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan, R.O.C
| | - Cheng Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan, R.O.C
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Hung-Chou Kuo
- Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan, R.O.C
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
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Mu L, Wang M, Cheng L, Chu G, Song Z. Atypical meningioma with destruction of cervical vertebrae inside the spinal canal: A case report and literature review. Oncol Lett 2024; 27:45. [PMID: 38106521 PMCID: PMC10722553 DOI: 10.3892/ol.2023.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Atypical meningioma is a specific type of meningioma that is relatively rare in clinical practice. The clinical manifestations of atypical meningioma are non-specific and the imaging findings are similar to those for other intraspinal space-occupying lesions. It is usually misdiagnosed as schwannoma or metastases, and it is necessary to rely on intraoperative findings and pathological examination to confirm the diagnosis. Atypical meningioma invading the intervertebral foramen and causing bone destruction is rare. The present study describes the case of a patient with cervical intraspinal atypical meningioma combined with cervical bone destruction. A 50-year-old female patient presented with numbness of the extremities with unstable walking, and underwent magnetic resonance imaging (MRI) of the cervical spine. MRI showed a space-occupying lesion in the spinal canal at the C2-4 level. The patient underwent cervical intraspinal lesion resection, and postoperative pathology confirmed atypical meningioma (World Health Organization grade II). The patient received dehydration and hormone therapy, and was discharged after the symptoms improved. Radiotherapy was performed 2 months after discharge. Cervical MRI 3 months after the operation showed that the tumor resection was satisfactory. To the best of our knowledge, the present study is the first to report on this specific type of meningioma. The present case report may provide useful information for clinicians to diagnose and treat the disease.
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Affiliation(s)
- Likun Mu
- Department of Neurosurgery, Shengli Oilfield Center Hospital, Dongying, Shandong 257099, P.R. China
| | - Mingxin Wang
- Department of Neurosurgery, Shengli Oilfield Center Hospital, Dongying, Shandong 257099, P.R. China
| | - Lifeng Cheng
- Department of Neurosurgery, Shengli Oilfield Center Hospital, Dongying, Shandong 257099, P.R. China
| | - Guangxu Chu
- Department of Neurosurgery, Shengli Oilfield Center Hospital, Dongying, Shandong 257099, P.R. China
| | - Zuyao Song
- Department of Neurosurgery, Shengli Oilfield Center Hospital, Dongying, Shandong 257099, P.R. China
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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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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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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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Abstract
PURPOSE OF REVIEW This article discusses the diagnosis and management of neoplasms that affect the spinal cord as well as spinal cord disorders that can occur due to cancer treatments. RECENT FINDINGS Neoplastic myelopathies are uncommon neurologic disorders but cause significant morbidity when they occur. Primary spinal cord tumors can be classified into intramedullary, intradural extramedullary, or extradural tumors. Diffuse gliomas and ependymal tumors are the most common intramedullary tumors. Diffuse gliomas include the World Health Organization (WHO) grade II and grade III astrocytomas, the grade II and grade III oligodendrogliomas, the grade IV glioblastomas, and newly recognized pediatric diffuse midline gliomas with H3 K27M mutation. The majority of diffuse and anaplastic astrocytomas are IDH-mutant tumors, whereas only 10% of glioblastomas are IDH-mutant. Oligodendrogliomas are typically IDH-mutant and are characterized by the molecular signature of 1p/19q codeletion. Nine distinct molecular subgroups of ependymomas have been identified based on their genetic features and location. NF2 mutations are frequently found in spinal cord ependymomas. Metastatic tumors are the most common tumors of the spine and can be extradural, leptomeningeal, or, rarely, intramedullary. Extradural metastatic spinal cord compression is a neurologic emergency and should be promptly diagnosed as pretreatment neurologic status dictates the posttreatment outcome. SUMMARY Neoplastic myelopathies encompass many diagnoses ranging from benign and malignant spinal tumors to paraneoplastic syndromes heralding cancers. The knowledge of the clinical features and management of neoplastic myelopathies is essential to practicing neurologists as early diagnosis and treatment can prevent devastating neurologic sequelae.
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Ghanchi H, Hariri OR, Takayanagi A, Li G. Multiple Extradural Spinal Meningiomas in a Patient with Acquired Immunodeficiency Syndrome: Case Report and Literature Review. World Neurosurg 2018; 117:366-370. [PMID: 29966786 DOI: 10.1016/j.wneu.2018.06.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Purely extradural spinal meningiomas are uncommon. Due to their typical location in the neural foramen, they are often mistaken for schwannomas, neurofibromas, and epidural metastases. In addition, comorbid conditions such as immunodeficiency may obscure the diagnosis. We present a case of extradural spinal meningiomas in a patient with human immunodeficiency virus (HIV). This is the first reported case of multiple extradural spinal meningiomas in 2 separate regions of the spine. CASE DESCRIPTION A 40-year-old male with a past medical history of HIV and hepatitis B infection presented with a 2-month history of progressive back pain radiating to the left flank and thigh. Magnetic resonance imaging of the thoracic and lumbar spine with intravenous gadolinium contrast revealed 2 extramedullary masses in the left neural foramina of T6 and L1. The patient underwent laminectomy, which revealed that the 2 lesions were entirely extradural. Both lesions were resected, and the histological diagnosis for both lesions was meningioma, World Health Organization grade I. CONCLUSIONS Our experience with this 40-year-old male with AIDS who presented with radicular symptoms due to multiple purely extradural meningiomas underscores the importance of considering meningioma as a possible diagnosis in patients with tumors of the neural foramina. In addition, a wide differential diagnosis should be made for patients with spinal lesions and history of HIV, including illnesses that are related to immunodeficiency and those that are not.
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Affiliation(s)
- Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA
| | - Omid R Hariri
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
| | - Ariel Takayanagi
- Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
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N’da H, Dauleac C, Toquart A, Afathi M, Meyronet D, Barrey C. Thoracic spine intra- and extradural dumbbell-shaped meningioma: Case report and extensive review of the literature with 21 cases. Neurochirurgie 2018; 64:206-210. [DOI: 10.1016/j.neuchi.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 02/06/2018] [Accepted: 03/03/2018] [Indexed: 02/03/2023]
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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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