- Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, Rome, Italy
- IRCCS Neuromed-Pozzilli, “Sapienza” University of Rome, Rome, Italy
IRCCS Neuromed-Pozzilli, “Sapienza” University of Rome, Rome, Italy
DOI:10.4103/sni.sni_200_17Copyright: © 2017 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: Paolo Missori, Valeria Palmarini, Maria Grazia Elefante, Marco Scapeccia, Maurizio Domenicucci, Sergio Paolini. Intradural angiomatous meningioma arising from a thoracic nerve root. 10-Aug-2017;8:187
How to cite this URL: Paolo Missori, Valeria Palmarini, Maria Grazia Elefante, Marco Scapeccia, Maurizio Domenicucci, Sergio Paolini. Intradural angiomatous meningioma arising from a thoracic nerve root. 10-Aug-2017;8:187. Available from: http://surgicalneurologyint.com/surgicalint-articles/intradural-angiomatous-meningioma-arising-from-a-thoracic-nerve-root/
Background:Spinal intradural meningiomas that arise purely from a nerve root without dural attachments are extremely rare. Spinal meningiomas arise from arachnoidal cap cells in the spinal canal, and growth of these tumors exerts pressure on the spinal cord and nerve roots.
Case Description:A patient presented with a lesion at the T3–T4 level that resembled a schwannoma on magnetic resonance imaging. During surgery, the tumor originated from a spinal nerve root. Pathologically, it was an angiomatous meningioma (AM).
Conclusions:In a review of the literature, we discuss the pathogenesis and surgical strategy for diagnosing and treating these extremely rare AM lesions.
Keywords: Angiomatous meningioma, arachnoidal sheet, intradural meningioma, spinal nerve, spinal tumors
Spinal intradural angiomatous meningiomas (AM) that arise purely from a nerve root, without any dural attachment, are extremely rare. Three intradural meningiomas (two AM) that arise from spinal nerves have been reported.[
Over 8 months, a 40-year-old male presented with gait instability, numbness, progressive lower extremity weakness. His neurological examination revealed reduced sensation below the T10 level, and urinary hesitancy. A magnetic resonance image (MRI) of the thoracic spine demonstrated a 3 × 1.4 × 1.5cm lesion compressing the spinal cord at the T3–T4 level [
A T3–T4 laminectomy was performed. Upon opening the dura, a reddish encapsulated tumor was observed [
Histopathology of the tumor revealed proliferation of meningothelial cells characterized by round-to-oval nuclei, small nucleoli, occasional pseudoinclusions, and abundant eosinophilic cytoplasm. Cells were arranged in cords and small nests, and they appeared to grow around/intermingled with numerous blood vessels [
In the vertebral canal, the parietal arachnoid membrane adheres to the dura mater, joins the visceral layer of the dura, and merges toward the spinal nerves near the root exit zones [
The parietal layer of the arachnoid membrane adheres to the dura mater and the visceral layer of the arachnoid membrane adheres to the pia mater of the spinal cord and nerves. Both join at the intervertebral foramina, but part of the arachnoidal sheet may extend into the extraforaminal space
It is not essential to preserve the nerve roots involved in spinal schwannomas, as in most cases, radical resection is possible without causing a neurological deficit. Here, we opted for a marginal resection of the AM tumor from an unidentified thoracic nerve root. The residual small fragment did not show any sign of recurrence on the follow-up MR 14 months later. In conclusion, spinal AMs can resemble schwannomas and may form firm attachments to a specific nerve root. Removal of these lesions can be accomplished without any nerve iatrogenic injury.
Financial support and sponsorship
Conflicts of interest
The authors declare that they received no funding, and the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
1. Benzel EC, Saunders Company WB.editors. Intradural extramedullary spinal lesions. Meningiomas. Spine Surgery Techniques, Complication Avoidance, and Management. Philadelphia: Elsevier/Saunders; 2012. p. 991-98
2. Hasselblatt M, Nolte KW, Paulus W. Angiomatous meningioma: A clinicopathologic study of 38 cases. Am J Surg Pathol. 2004. 28: 390-3
3. Krishnan KL, Narayanan R, Kalyanaraman S, Ramamurthi B. Spinal epidural meningioma. Int Surg. 1978. 63: 42-3
4. Kumar S, Kaza RC, Maitra TK, Chandra M. Extradural spinal meningioma arising from a nerve root. Case report. J Neurosurg. 1980. 52: 728-9
5. Mizutani J, Fukuoka M, Tsubouchi S, Otsuka T, Tono Y, Shimizu S. A rare case of lumbosacral meningioma: Nondural attachment and possible enlargement by orally administered sex steroid. Spine (Phila Pa 1976). 2002. 27: E377-81
6. Ng TH, Chan KH, Mann KS, Fung CF. Spinal meningioma arising from a lumbar nerve root. Case report. J Neurosurg. 1989. 70: 646-8
7. Wu L, Yang T, Yang C, Deng X, Fang J, Xu Y. Surgical treatment of intraspinal angiomatous meningiomas from a single center. Neurol Med Chir (Tokyo). 2015. 55: 328-35