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Extradural meningioma en-plaque of the cervical cord
1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Abstract:
A rare case of cervical extradural en-plaque meningothelial meningioma is reported. The magnetic resonance imaging revealed an extradural sheet of tumor encasing the cervical cord from anterior, posterior and right lateral aspects and emerging from the right C3-4 intervertebral foramina. Though a differential diagnosis of lymphoma and tubercular granulation tissue were considered, its isointense intensity patterns on T1 and T2 weighted images and the intratumoral calcification on intrathecal contrast computed tomographic scan suggested a meningioma. At surgery, the lesion was fibrous, avascular and densely adherent to the dura. The radiological features and management options of the lesion are discussed.
Insights
A rare cervical extradural en-plaque meningioma encasing the spinal cord was identified. Surgical removal was performed, and the case highlights diagnostic challenges and management strategies for this unusual spinal tumor.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Meningiomas, typically benign tumors arising from the meninges, are rare in the extradural spinal compartment.
- En-plaque meningiomas, characterized by their flattened, plaque-like growth, present unique diagnostic and surgical challenges, especially when located in the cervical spine.
Observation:
- A rare case of cervical extradural en-plaque meningioma is presented, involving the C3-4 intervertebral foramina.
- Magnetic resonance imaging (MRI) demonstrated an extradural tumor sheet encasing the cervical cord anteriorly, posteriorly, and laterally.
- Differential diagnoses included lymphoma and tubercular granulation tissue, but imaging characteristics, including isointense T1/T2 signal and intratumoral calcification on CT, suggested meningioma.
Findings:
- Surgical exploration revealed a fibrous, avascular lesion densely adherent to the dura.
- The tumor's extradural, en-plaque nature and extensive encasement of the cervical cord posed significant surgical challenges.
- Histopathological confirmation of meningioma was obtained post-operatively.
Implications:
- This case underscores the importance of considering meningioma in the differential diagnosis of extradural cervical spinal masses, even with atypical imaging features.
- Accurate radiological assessment is crucial for pre-operative planning and surgical strategy in managing these challenging lesions.
- Understanding the radiological features and management options for cervical extradural en-plaque meningiomas can improve patient outcomes.