Giant ventral intradural extramedullary neuroma: case report

Area of Science:

• Neurosurgery
• Spinal Oncology
• Neuropathology

Background:

• Intradural extramedullary spinal tumors are rare, with neuromas being a common subtype.
• Giant neuromas, particularly those with extensive rostrocaudal and ventral extension, present significant surgical challenges.
• This report focuses on an unprecedentedly large neuroma impacting the entire spinal canal.

Purpose of the Study:

• To document an extremely rare case of a giant, ventrally located, intradural extramedullary neuroma.
• To describe the clinical presentation, diagnostic imaging, and surgical management of this massive spinal tumor.
• To emphasize the importance of preoperative diagnosis and surgical technique in achieving successful outcomes for complex spinal neoplasms.

Main Methods:

• A 32-year-old woman presented with symptoms of a large spinal tumor.
• Diagnosis was established using magnetic resonance imaging (MRI) of the entire neuraxis.
• Surgical resection was performed via an osteoplastic laminotomy (C1-T10) with intraoperative neuromonitoring (somatosensory evoked potentials).

Main Results:

• The neuroma measured significantly larger than any previously reported intraspinal neuroma, extending from the foramen magnum to the T10 vertebral level.
• Complete surgical excision of the tumor was achieved.
• Postoperative outcomes were favorable, with no mention of residual symptoms or complications.

Conclusions:

• Giant, ventrally located, intradural extramedullary tumors, even of extreme size, are amenable to complete surgical resection.
• Modern magnetic resonance imaging (MRI) allows for detailed delineation of neural and vascular structures, minimizing the need for invasive diagnostic procedures.
• Osteoplastic laminotomy is recommended over laminectomy to prevent postoperative spinal instability.