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Lumbar angiomatous meningioma: how to manage this rare entity? A case report
Soumya El Graini1, Ibrahima Diallo Dokal1, Sara El Ghaffouli2
1Radiology Department - Ibn Sina University Hospital, University Mohamed V, Rabat, Morocco.
Introduction:
Spinal meningiomas (SM) are rare intradural extramedullary tumors arising from arachnoid cells of the leptomeninges. They are most commonly found in the thoracic region, with angiomatous subtypes being even rarer and carrying a high hemorrhagic risk. Diagnosis and treatment are guided by clinical presentation and imaging, with surgery being the primary therapeutic approach. Recurrence is uncommon, occurring in 1.3 % to 6.4 % of cases, and decisions between surgery and adjuvant treatments like radiotherapy depend on factors such as tumor location, histological subtype, and the surgeon's expertise. This case aims to explore the radiological features and treatment strategies for SM.
Case Presentation:
A 58-year-old man with a history of disc herniation surgery presented with lower back pain, bilateral sciatica, cruralgia, and sphincter dysfunction. Spinal MRI revealed an intra-dural, extra-medullary tumor, which was surgically removed and the patient had an uneventful postoperative recovery. Histopathological examination confirmed an angiomatous meningioma (WHO Grade 1).
Clinical Discussion:
SM are rare tumors, often causing pain and neurological issues. Imaging is crucial in assessing tumor extent and vascularization, helping in treatment decisions. Although recurrences aren't common, they are usually treated surgically, with adjuvant therapies like radiotherapy being considered for high-grade or inoperable tumors. Further research is needed to refine the understanding and management of spinal meningiomas.
Conclusion:
SM are exceptional, mostly benign, slow-growing tumors, with surgical resection remaining the primary treatment and offering low recurrence rates. Adjuvant therapies, including radiotherapy and molecular-targeted treatments, remain largely investigational, with no established clinical application.
Insights
Spinal meningiomas (SM) are rare tumors. Surgical removal is the primary treatment, offering low recurrence rates for these slow-growing, mostly benign growths.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Spinal meningiomas (SM) are rare intradural extramedullary tumors originating from leptomeningeal arachnoid cells.
- Angiomatous subtypes are particularly rare and associated with a high risk of hemorrhage.
- Diagnosis and treatment are guided by clinical presentation and advanced imaging techniques.
Observation:
- A 58-year-old male presented with symptoms including lower back pain, bilateral sciatica, cruralgia, and sphincter dysfunction.
- Spinal MRI identified an intradural, extramedullary tumor.
- Surgical resection was performed, followed by an uneventful recovery, with histopathology confirming a WHO Grade 1 angiomatous meningioma.
Findings:
- Spinal meningiomas are typically benign and slow-growing, with surgical resection being the standard treatment.
- Recurrence rates for spinal meningiomas are generally low, ranging from 1.3% to 6.4%.
- Adjuvant therapies like radiotherapy are considered for high-grade or inoperable tumors, but their role remains investigational.
Implications:
- Accurate radiological assessment is crucial for surgical planning and treatment decisions in spinal meningioma cases.
- While surgical resection is effective, further research is needed to optimize management strategies and understand the role of adjuvant therapies.
- This case highlights the importance of timely diagnosis and surgical intervention for spinal meningiomas to improve patient outcomes.
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