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Extradural en-plaque spinal meningioma with intraneural invasion
Jayshree Tuli1, Dan Michael Drzymalski, Hart Lidov
1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Background:
Extradural spinal meningiomas are rare. Our understanding of purely extradural spinal meningiomas is incomplete because most reports rarely differentiate purely extradural meningiomas from extradural meningiomas with an intradural component. Occasionally, reports have described involvement of the adjacent nerve root, but there has never been a description of an extradural meningioma that actually infiltrates the nerve root.
Case Description:
A 42-year-old woman presented with progressive lower extremity weakness and numbness below T3 during the span of 4 months with imaging evidence of an extradural lesion compressing the cord from T4 through T6. Surgical resection revealed an extradural mass extending through the foramen at T5-6 and encompassing the cord and T5 root on the left. Pathologically, the lesion was a World Health Organization grade I meningioma with nerve root invasion and a concerning elevated mindbomb homolog 1 (MIB-1) of 9.4%.
Conclusions:
Purely extradural meningiomas are rare, and our case is one of the first to describe a patient with an extradural meningioma that actually infiltrates the nerve root. Extradural spinal meningiomas are usually not adherent to the dura, but only appear to be adherent or invade (as in our patient) the adjacent nerve root. They are easily mistaken preoperatively and grossly intraoperatively for malignant metastatic tumors and can change the proposed surgical treatment. The long-term prognosis remains uncertain, but our patient's last follow-up suggests a favorable prognosis.
Insights
This case study highlights a rare purely extradural spinal meningioma infiltrating a nerve root, challenging previous understandings of these tumors. The findings suggest a need for careful preoperative evaluation and surgical planning for extradural spinal meningiomas.
Area of Science:
- Neurosurgery
- Spinal Oncology
- Pathology
Background:
- Extradural spinal meningiomas are uncommon tumors.
- Distinguishing purely extradural from intradural meningiomas is challenging.
- Nerve root involvement is rarely described and infiltration is unprecedented.
Observation:
- A 42-year-old woman presented with progressive neurological deficits.
- Imaging revealed an extradural lesion compressing the spinal cord.
- Surgical resection identified a World Health Organization grade I meningioma with nerve root invasion.
Findings:
- This is one of the first reported cases of an extradural meningioma infiltrating a nerve root.
- The tumor exhibited a high MIB-1 proliferation index (9.4%).
- Extradural meningiomas can mimic malignant tumors, impacting surgical strategy.
Implications:
- This case expands the understanding of extradural spinal meningioma behavior.
- Accurate preoperative diagnosis is crucial for appropriate surgical management.
- Despite nerve root invasion, a favorable prognosis was observed in this patient.
