Case Report: Upper Thoracic Purely Extradural Spinal Meningioma With Nerve Root Attachment: A Case Report and Literature Review

Abstract

IntroductionWe describe a case of purely extradural spinal meningioma (EDSMs) with nerve root attachment and present the clinical profiles, radiological findings, operative management, and follow-up data, along with a literature review. This case study is purely extradural spinal meningioma attached to the nerve root, and the available literature review discusses the diagnosis and treatment. Purely epidural spinal meningiomas are extremely rare, and only a few clinical reports are published on this disease. Although epidural meningioma is a benign tumor, the recurrence rate is higher when compared with ordinary meningioma.Case studyA 39-year-old male complained of chest and back pain with ring-shaped radiations to the precordial area and numbness in both the lower extremities. After a long walk, he felt disharmony in both his lower limbs. Magnetic resonance imaging showed a mass located on the left posterolateral side of the T1–T3 spinal cord and exhibited a dumbbell-type growth outward at the level of the T2–T3 intervertebral foramen. On the left side of the thoracic, a hemilaminectomy procedure was performed. The tumor was found in the ventral side of the left nerve root of T1 and was surrounded by the left nerve root of T2. To obliterate the tumor, the T2 nerve root was severed. The patient was advised to come for the follow-up on the 3rd, 6th, and 12th months postoperatively, and there were no complaints or signs of recurrence.ConclusionPurely extradural spinal meningioma with nerve root attachment is rare and has no clinical symptoms and image findings. To completely resect the lesion and avoid recurrence, the affected nerve root, epidural fat tissue, and nerve root sheath should be extensively resected and burned, coagulating the adjacent ventral posterior longitudinal ligament.

Sacral extradural spinal meningioma with recurrence; a case report

“…MRI is often regarded as the optimal diagnostic technique (20). T1-weighted isosignal and T2-weighted isosignal/hypersignal were frequent radiologic results, and contrast application mostly reveals a homogeneous enhancement along with the dorsally or ventrally situated epidural meningioma in the dural sac (11).…”

“…The majority of meningiomas are found in the brain, however spinal meningiomas make up approximately 1.2% to 12.5% of all meningiomas (10). Spinal meningiomas can occur anywhere along the spinal cord, with approximately 70% in the thoracic spine, 25% in the cervical spine, and 5% in the lumbar spine (11).…”

“…Intraspinal masses signal probable clinical symptoms necessitating as soon as possible surgical excision of all malignancies for spinal canal decompression (21). The primary clinical determinant of recurrence is the extent of tumor resection, young age, higher pathologic grade, and calcifications (22); therefore, complete removal should be the first objective in order to eradicate the lesion completely and avoid its recurrence (11,23). Even while performing full excisional surgery on certain tumors, such as the one reported in this case report, is difficult owing to the closeness to the nerve root in the foramen, it is often carried out using isolated posterior procedures (24).…”

“…Additionally, it is administered after total or subtotal resection to prevent early recurrence. Furthermore, in cases where surgical treatment poses significant medical risks, reoperation should be performed upon early recurrence, followed by radiotherapy (11). Several recent studies have indicated stereotactic radiotherapy, such as CyberKnife, for the management of spinal meningioma growth and recurrence (28).…”