Decompensation of a Thoracic Meningioma Below the Operated Level: A Dramatic and Unexpected Complication

Paraplegia after lumbar spinal surgery has been previously described. It was generally provoked by a missed thoracic compression because of degenerative processes, arachnoid cyst, and spinal cord tumor such as meningioma. We describe here a case of a patient with neurofibromatosis type 2 (NF-2) with multiple spinal meningiomas that developed postoperative paraplegia because of decompensation of spinal cord compression below and far from the operated level.

A 54-year-old woman with NF-2 was followed-up for multiple spinal meningiomas (C7-T1, T6-7, T9-10 levels). Surgery for the symptomatic and larger lesion (C7-T1) was scheduled. Postoperatively, the patient was found to have paraplegia with sensor anesthesia below the level of the T6 vertebra. An urgent spinal magnetic resonance imaging (MRI) scan was performed revealing the absence of complication at the operated level (C7-T1) but the appearance of a marked intramedullary hyperintensity at the T6-7 level. An urgent T6-7 laminectomy and removal of the meningioma was performed. The postoperative phase was marked by a poor recuperation. Spinal MRI scan at 3 months clearly showed a severely injured spinal cord at the T6-7 level consistent with the neurologic status of the patient.

We report here the first case of acute neurologic deterioration after decompensation of a spinal cord compression below the operated level in spinal intradural surgery. Neurosurgeons must be aware of this possible complication when treating patients with multiple spinal meningiomas.