Background: Malignant peripheral nerve sheath tumors (MPNSTs) typically found in the trunk, limbs, head, and neck represent 3–10% of all soft-tissue sarcomas. Although they typically originating from peripheral nerve Schwann cells, 2–3% arise from the spinal nerves and may be found within the spinal canal. Here, we present a 43-year-old male with an extradural thoracic MPNST contributing to marked cord compression and a progressive paraparesis. Case Description: A 43-year-old male presented with a progressive paraparesis of 16 months’ duration. The MRI showed a posterior T2-T4 extradural tumor in the thoracic spine resulting in significant cord compression. Following a T2-T4 laminectomy and gross total excision of the epidural mass, the patient regained modest neurological function. Immunohistochemistry staining supported the diagnosis of thoracic spinal MPNST. Conclusion: Rarely, spinal MPNST can be considered amongst the differential diagnoses of an extradural spinal tumor. In this case, gross total excision of a posterior T2-T4 epidural MPNST resulted in improvement in the patient’s original paraparesis. Notably, immunohistochemistry staining helped confirm the diagnosis of a MPNST.

Introduction: Foramen magnum meningiomas (FMMs) arise from meningothelial cells of arachnoid layer in the craniospinal junction. FMMs are rare and comprise only 1.8 to 3.2% of all meningiomas. Patients with FMMs generally have vague symptoms and are often misdiagnosed. Surgical management of FMMs poses a challenge because foramen magnum is a highly complex territory of the skull base and contains many important and vital structures. Up until this date, the surgical approaches for FMMs that arise anterolaterally remain varied. We aimed to present a case of anterolateral FMM that was successfully managed through posterior suboccipital midline approach. Case presentation: A 49-year-old female presented with chief complaint of tetra paresis for the past 4 months. Initially, she was experiencing tingling and numbness on her right neck radiating to her right hand. Her symptoms were worsened, radiating to all of her four extremities along with progressive motor weakness that made her unable to walk. Whole spine MRI was performed and anterior meningioma extending to the right side at the level of foramen magnum was found. The posterior suboccipital midline approach with C1 laminectomy and C2 partial superior laminectomy was performed. The patient made a good recovery immediately after the surgery and there was no recurrence of her symptoms during 4 months follow-up. Conclusion: Surgical approaches for FMM remain varied according to several studies. However, the surgical strategy should be patient-tailored to achieve the maximal resection and prevent morbidity. As for our case, posterior suboccipital midline approach is safe and feasible surgical procedure to treat anterolateral FMM.