Surgical Treatment of Spinal Intra-Extradural Meningioma: A Clinical Case

Abstract

Spinal meningiomas are rare, predominantly benign tumors that exhibit slow growth and typically have a non-invasive pattern of development. They originate from arachnoid cells and fibroblasts of the dura mater. Despite their benign nature, some meningiomas can exhibit intra-extradural extension, complicating both diagnosis and treatment. This article presents a clinical case involving a patient with an intra-extradural spinal meningioma. Despite radiological imaging suggesting a neurinoma, the final diagnosis confirmed a meningioma.

Case Report: A female patient underwent surgical tumor resection through a posterolateral approach with laminectomy and facetectomy at the C4-C5 vertebral levels. The tumor, extending through the intervertebral foramen, was completely resected along with the affected nerve root. Histological examination verified a Grade II meningioma.

Discussion: Despite advancements in neuroimaging and surgical techniques, intraoperative findings can be unpredictable, necessitating an adaptive approach to tumor resection. The article emphasizes the importance of adequate preoperative planning and the use of intraoperative neurophysiological monitoring to reduce the risk of complications and improve treatment outcomes.

Conclusions: The primary treatment for spinal meningiomas is surgical. For dorsal and lateral localizations, total resection with the involved dura mater (Simpson Grade I) is optimal. For ventral localizations, tumor resection with coagulation of the dural attachment site (Simpson Grade II) is preferred. Preoperative and intraoperative use of electrophysiological methods is recommended to assess the functional status of neural structures. Intra-extradural localization of meningiomas is rare and presents significant challenges in preoperative diagnosis, requiring specific skills for effective removal.