Microsurgical excision of multiple clear cell meningiomas of the cauda equina: a case report

We report the case of a 21-year-old woman who presented with a 2-year history of worsening radicular pain on the right leg. The Valsalva manoeuvre provoked radicular pain and radiography showed right-convex 36 degrees scoliosis. Examination showed slight hypoesthesia on the right L3-S1 dermatomes but abnormal muscle power and reflexes. Magnetic resonance imaging identified cauda equina tumours at the L2-3 and L4 levels. The tumours showed heterogeneously isointense signals on T(1)-weighted image, hypointense signals on T(2)-weighted image, and hyperintense signal on gadolinium-enhanced T(1)-weighted sequences. The tumour was microsurgically extirpated from the cauda equina and resected through multiple small laminotomies. Macroscopically, the tumours were poorly encapsulated, hard in consistency, adherent to the adjacent cauda equinas, irregularly shaped like a "horseradish", and yellowish-grey in colour. Histopathological diagnosis was clear cell meningioma.