No abstract

clinicaltrials.gov Identifier: NCT00094575.

STUDY DESIGN.: Case report and literature review. OBJECTIVES.: To report the very rare case of a mature intramedullary teratoma with exophytic extension localized to the uppermost cervical spinal level in a 65-year-old woman and review the pertinent medical literature. SUMMARY OF BACKGROUND DATA.: Cervical intramedullary teratomas are extremely rare in adults, especially in patients older than 50 years. METHODS.: The patient presented with progressive ataxia, mild bilateral kinetic hand tremors, and dizziness. Magnetic resonance imaging revealed an intramedullary 1.7 x 1.3 x 2.3 cm mass at C1 with exophytic extension. A C1-C2 laminectomy and a partial suboccipital craniotomy were performed, followed by a subtotal microscopic resection of the tumor. Pathology was consistent with a mature teratoma. RESULTS.: After surgery, the patient's ataxia, tremor, and dizziness resolved almost immediately. CONCLUSION.: This report presents the very rare case of a mature intramedullary teratoma located in the upper cervical spine of an elderly patient, possibly the oldest patient documented with this type of lesion. The authors recommend a conservative subtotal surgical resection of cervical intramedullary tumors because it may improve symptoms that relate to direct mechanical cord compression and avoid further harm from a gross resection.

Background: Intracranial meningiomas are rare in individuals under age 30 years. The purpose of this study was to analyze the demographics and clinical features of intracranial meningiomas in individuals under age 30 years. Methods: A retrospective analysis of clinical, radiographic, and pathology data of patients under age 30 years who presented with an intracranial meningioma was performed. Results: Thirty five patients met the criteria. Mean age was 25 years, 11 were male and 24 female. Five patients had previous radiation exposure. The presenting symptom was headache in 16 patients (45.7%) and seizure in 9 (25.7%). Cranial base tumors comprised 74%; 26% were supratentorial. Simpson grade 1 or 2 resection was achieved in 16 patients (48.5%); grade 3 or 4 resection was achieved in 17 patients (51.5%). Tumor pathologic grade was WHO grade I in 27 (77.1%), grade II in 6 (17.1%) and grade III in 2 patients (5.7%). Postoperative radiation therapy for tumor progression was administered in 13 patients. Radiographic follow-up was available in 26 patients at an average of 6.1 years after surgery; of these, 14 had no recurrence or progression of residual tumor while 12 had recurrence or progression. Recurrence was more common in patients with WHO grade II and III tumors and radiation-induced meningiomas. Recurrent tumors tended to have a higher WHO grade. Conclusion: In this group of intracranial meningiomas in individuals <30 years, ionizing radiation was a risk factor and tumors were more common in females. A higher percentage of WHO grade II and III tumors at presentation and recurrence was noted. Recurrent tumors were more common in patients with higher WHO grade and in radiation-induced meningiomas.