- Operative Unit of Neurosurgery, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy
- Department of Pathology, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy
- MESVA Department, University of L’Aquila, L’Aquila, Italy
Soheila Raysi Dehcordi
Operative Unit of Neurosurgery, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy
DOI:10.4103/2152-7806.188914Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Dehcordi SR, Ricci A, Chiominto A, Paulis DD, Vitantonio HD, Galzio RJ. Dorsal extradural meningioma: Case report and literature review. Surg Neurol Int 23-Aug-2016;7:76
How to cite this URL: Dehcordi SR, Ricci A, Chiominto A, Paulis DD, Vitantonio HD, Galzio RJ. Dorsal extradural meningioma: Case report and literature review. Surg Neurol Int 23-Aug-2016;7:76. Available from: http://surgicalneurologyint.com/surgicalint_articles/dorsal-extradural-meningioma-case-report-literature-review/
Background:Extradural spinal mass lesions are most commonly metastatic tumors. Extradural meningiomas are rare, accounting for approximately 2.5–3.5% of spinal meningiomas; intraoperatively, they are easily mistaken for malignant tumors, especially in the en plaque variety, resulting in inadequate surgical treatment.
Case Description:Our case is one of the first to describe a patient with two purely extradural meningiomas, one each between D3–D4 and between D5–D6 vertebral levels. Surgical resection was radical, and pathologically both lesions were meningothelialmeningiomas.
Conclusions:Reviewing the literature, we discuss the pathogenesis, treatment strategies, and long-term behavior of these uncommon lesions.
Keywords: Extradural extramedullary neoplasms, extradural meningioma, extradural spinal tumors
Vertebromedullary tumors are classified as either extradural or intradural. Intradural tumors are further divided into intramedullary or extramedullary. The most common intradural extramedullary neoplasms are schwannomas, neurofibromas, and meningiomas. Extradural tumors are most commonly metastatic lesions.[
Meningiomas account for 25–46% of primary spinal tumors,[
We report a rare case of two purely extradural thoracic spine meningiomas in a young woman suffering from meningiomatosis. We discuss the features and clinical management of entirely extradural meningiomas.
A 39-year-old woman, suffering from meningiomatosis, was operated in our institute several times. The first operation was performed in 2006, when she underwent exeresis of a paramedian meningioma (meningothelialmeningioma) arising in the right paramedian region. In 2009, she presented with a gran mal seizure and left hemiparesis; magnetic resonance imaging (MRI) revealed multicentric meningiomas in the right parietal paramedian and bilateral falcine regions. These lesions were partially removed and the postoperative course was good, with an improvement in her seizures and weakness. In addition, in this case, the histological diagnosis was meningothelialmeningioma. Therefore, after operation, the patient was subjected to radiotherapy and a close neuroradiologic follow-up. Since February 2015, she noted progressive numbness and weakness in both lower extremities with gait disturbance. She denied sphincter disturbance.
Spine magnetic resonance imaging (MRI) showed an extramedullary mass, located between D3–D4 vertebral levels, extending to the left D3–D4 foramen [
Neurological examination revealed a severe paraparesis with motor strength of 2/5 in both legs (left more than right) and a T6 sensory level bilaterally. A mild weakness in her arm was also noted (outcome of previous intervention). The following deep tendon reflexes were exaggerated: Bilateral knee jerk, bilateral ankle jerk, and bilateral medial hamstrings. Left-sided Babinski reflex was noted. General physical examination was normal.
Using an operative microscope, the patient underwent a radical surgical excision of both lesions by D4 laminectomy and D5 left partial hemilaminectomy. Two purely extradural tumors were found intraoperatively; lesions were found to be gray, with hard consistency, along with calcifications and signs of bone erosion. Intraoperative findings were suggestive of a metastatic extradural and vertebral secondary location (even if no primary lesion was found in the preoperative laboratory and radiological evaluation). Extradural masses were completely removed and dural basements were cauterized [Figures
Postoperatively, there was a marked improvement in the muscle strength of the lower extremities; follow-up neuroimaging revealed complete removal of lesions and no spinal instability. No apparent tumor recurrence or regrowth was detected in a follow-up study 6 months later.
Exclusively extradural meningiomas are very rare, accounting for 2.5–3.5% of spinal meningiomas.[
Several theories have been postulated for the pathogenesis of purely extradural meningiomas. They are believed to arise from ectopic arachnoid cells around the periradicular nerve root sleeve, where the spinal meninx merges directly into the dura,[
Concerning neuroimaging, MRI is the technique of choice for the diagnosis of spinal meningiomas; it clearly defines the mass and its relation to the spinal cord.[
Various studies have provided contradicting reports for the long-term prognosis of patients with extradural spinal meningiomas. Some authors have asserted the aggressive behavior of these tumors, others have demonstrated these meningiomas to be benign.[
Purely extradural meningiomas are very infrequent but they should be included in the differential diagnosis of extradural lesions. They are easily mistaken pre and intraoperatively for metastatic tumors, with possible consequences on the proposed surgical treatment, and therefore, on the morbidity. Because prognosis is related to the extent of resection, we believe it would be better to completely remove the lesion, if considered safe. In case of doubts, an intraoperative pathology support could be useful. Finally, because of opposing views in the long-term prognosis and rate of surgical cure, it is very important to be aware of these lesions, undergoing patients to very close follow-ups.
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