Giant ventral intradural extramedullary neuroma: case report

OBJECTIVE AND IMPORTANCE: We report an extremely rare, giant, ventrally located, intradural extramedullary neuroma in a 32-year-old woman. It extended from the foramen magnum to the level of the 10th thoracic vertebra. To our knowledge, this is the largest reported intraspinal neuroma. CLINICAL PRESENTATION: A mixed polyradicular and medullary lesion with symptoms and signs of raised intracranial pressure was observed on clinical presentation. Magnetic resonance imaging of the entire neuraxis was suggestive of a neuroma. Histological findings revealed characteristics of a classic neuroma. INTERVENTION: A complete surgical excision of the tumor was accomplished through an osteoplastic laminotomy from C1 to T10 with monitoring of the somatosensory evoked potentials. CONCLUSION: Even such a huge, ventrally located, intradural extramedullary tumor, as in this patient, can be completely removed with good results when a preoperative radiological and histological diagnosis is considered. With the help of new-generation magnetic resonance imaging scans, the intradural neural, vascular, and other structures can be clearly outlined. These tests also obviate the need for invasive diagnostic procedures such as myelography. We recommend an osteoplastic laminotomy instead of laminectomy to reduce the risk of postoperative spinal instability.