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Intraspinal clear cell meningioma without dural attachment: A case report and literature review
Xiaolei Zhang1, Peihai Zhang, James Jin Wang
1Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Rationale:
Clear cell meningioma (CCM) is one of the rarest but most aggressive forms of meningioma, with a tendency to occur at a high recurrence rate. Intraspinal CCM, especially the nondura-based type, is even rarer than the intracranial CCM.
Patient Concerns:
We report a case of a 45-year-old woman who presented with a 1-month history of episodic pain in the lower back and in both thighs in the front side. Femoral nerve stretch tests were positive on both sides. Magnetic resonance imaging (MRI) demonstrated an intradural tumor at the L3 level, which was isointense on T1- and T2-weighted images (WI) and homogeneously enhanced on gadolinium-contrast T1 WI.
Diagnoses:
The space-occupying lesion was pathologically confirmed as CCM.
Interventions:
During surgery, we found that the tumor adhered to a nerve root, without dural attachment. The nerve root was partially removed to achieve complete resection.
Outcomes:
The pain disappeared after the operation. The 1 year follow-up MRI revealed no evidence of tumor recurrence or metastasis.
Lessons:
Nondura-based intraspinal CCM is easier to completely remove, and such complete removal should be achieved during the first operation. Although the recurrence rate of this particular type of meningioma appears to be lower than that of other types, close clinical and radiological follow-up is necessary.
Insights
Clear cell meningioma (CCM) is a rare, aggressive tumor. This case highlights successful surgical removal of a nondura-based intraspinal CCM, with no recurrence after one year, emphasizing early complete resection.
Area of Science:
- Neurosurgery
- Oncology
- Spinal Cord Tumors
Background:
- Clear cell meningioma (CCM) is a rare and aggressive subtype of meningioma.
- Intraspinal CCM, particularly nondura-based variants, are exceptionally uncommon.
Observation:
- A 45-year-old woman presented with lower back and anterior thigh pain.
- MRI revealed an intradural, isointense tumor at L3, enhancing after contrast.
- The tumor was pathologically confirmed as clear cell meningioma.
Findings:
- Surgical resection involved partial removal of an adhered nerve root for complete tumor removal.
- Post-operative pain resolved completely.
- One-year follow-up MRI showed no evidence of recurrence or metastasis.
Implications:
- Nondura-based intraspinal CCMs may be amenable to complete resection during initial surgery.
- While potentially having a lower recurrence rate, diligent clinical and radiological surveillance remains crucial for these rare tumors.
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