Epidural meningioma of the sacral canal. Case report

Spinal meningiomas are reported infrequently as pure epidural tumors, and they are rarely located at the caudal end of the spine. The unique combination of a wholly epidural tumor confined entirely to the sacral canal has not been previously described. The authors describe the case of a 29-year-old man who presented with coccygeal and left-sided S2-4 dermatomal pain. Examination confirmed sensory loss in the same distribution. A magnetic resonance image revealed an enhancing mass lesion in the sacral canal scalloping the bone at S-2 and S-3. An apparent complete resection was performed. Intraoperatively the authors observed an entirely epidural tumor with a small dural attachment at the most caudal end of the thecal sac. Histological examination confirmed that the tumor was an atypical meningioma. A local recurrence developed within 1 year of surgery, and the patient underwent a hemisacrectomy for tumor removal. An additional recurrence in the lumbosacral spine and multiple pulmonary metastases developed thereafter. In addition to the unique nature of this case, the authors also observed a tumor behaving in a far more aggressive fashion than its histological findings would suggest. This adds to the differential diagnosis of tumors occurring in the sacral canal.