Unveiling the Unexpected: Co-Occurrence of Brain Tumor and Spine Pathology Revealed After Spinal Surgery

Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction. Because its symptoms may resemble those of intracranial tumors, patients can be misdiagnosed and undergo inappropriate spinal procedures. We describe three patients initially treated with cervical decompression under the impression of CSM. In each case, neurological deficits failed to improve, or even progressed, despite adequate surgery. Further investigation with brain MRI disclosed large meningiomas located in the frontoparietal or parasagittal regions. All tumors were completely resected, pathology confirmed WHO Grade I meningioma, and the patients showed meaningful neurological recovery. These observations remind us that neurological findings must be interpreted in parallel with cervical imaging. A brain MRI should be obtained whenever clinical features are disproportionate to spinal pathology, extend beyond the usual pattern of myelopathy, or remain unresolved after decompression.