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Intramedullary sclerosing meningioma: operative video
Giada Garufi1,2, Giuseppe Ricciardo1, Alfredo Conti3
1Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, Italy.
Abstract:
Sclerosing meningiomas (SMs) represent a rare histological variant of meningiomas, first described in 1989 as invasive bulking masses of whorling collagen bundles with a minimum percentage of meningothelia-resembling cells, and they are often misdiagnosed. The literature reports only 30 cases of SMs, with only two of them being intramedullary. The authors present the case of a patient with a cervical intramedullary SM who presented with gait disturbances, sensory deficits, weakness in four extremities, and hyperreflexia. The surgery was performed under neurophysiological monitoring and after administration of sodium fluorescein, which allowed us to discriminate the exact myelotomy point. Intramedullary SMs are very rare entities whose correct management may result in a good outcome.
Insights
Sclerosing meningiomas (SMs) are rare tumors. This case highlights the successful surgical management of a cervical intramedullary SM, emphasizing precise surgical techniques for a favorable outcome.
Area of Science:
- Neurosurgery
- Neuropathology
Background:
- Sclerosing meningiomas (SMs) are a rare histological subtype, characterized by collagenous stroma.
- SMs are infrequently diagnosed, with limited reported cases, especially intramedullary variants.
Purpose of the Study:
- To present a rare case of cervical intramedullary sclerosing meningioma.
- To discuss the diagnostic and surgical management of this rare entity.
Main Methods:
- Case report of a patient with a cervical intramedullary SM.
- Surgical resection performed under neurophysiological monitoring.
- Sodium fluorescein used for precise myelotomy localization.
Main Results:
- The patient presented with neurological deficits including gait disturbance and quadriparesis.
- Successful surgical removal of the intramedullary SM was achieved.
- The use of sodium fluorescein aided in accurate surgical planning.
Conclusions:
- Intramedullary sclerosing meningiomas are exceptionally rare.
- Accurate surgical management, aided by techniques like intraoperative visualization, can lead to good patient outcomes.
