Primary intraosseous meningioma of the vertebra: illustrative case

Abstract

BACKGROUND Primary intraosseous meningiomas (PIMs) are rare, and PIMs of the vertebrae have not yet been reported. The authors report a case of primary meningioma arising from the vertebrae. OBSERVATIONS A 49-year-old man presented with lower back pain and numbness in both lower extremities. Lumbar spine magnetic resonance imaging revealed an L2 pathological fracture with epidural and paraspinal invasion. The patient had undergone a first palliative decompression and fixation surgery, and the diagnosis turned out to be a World Health Organization grade III anaplastic meningioma based on histopathology. The tumor had progressed after first operation and radiation therapy, and the patient was referred to the authors’ institute for excision. The patient had an uneventful postoperative course after a revisional total en bloc spondylectomy of L2. LESSONS The authors present a rare case of PIM of the vertebrae with epidural and paraspinal invasion. Careful preoperative assessment and surgical planning is crucial for successful patient management.

Spinal meningiomas

“…Primary intraosseous meningioma of the spine is an exceptionally rare tumor entity with only one case reported in the literature so far. 47 More importantly, CT provides information about the presence and extent of tumor calcification, which is a relevant factor to consider in surgical planning as calcified tumors can be more difficult to resect. Tumor texture can influence surgical morbidity and outcome as recently shown for intracranial meningiomas.…”