Paraplegia as a Severe Presentation of an Unusual Form of Ossified Intradural Meningioma: Case Report
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IMAGING
Paraplegia as a Severe Presentation of an Unusual Form of Ossified Intradural Meningioma: Case Report Najeeb Saleh Aljalal 1 & Sultan Abdulwadoud Alshoabi 2 Accepted: 27 August 2020 # Springer Nature Switzerland AG 2020
Abstract Ossified meningioma is a rare type of intradural, extramedullary spinal meningioma which may give a bone density in the spinal canal and complicate surgical removal of the meningioma. This report discusses a case of ossified meningioma in a 60-year-old female patient who presented with paraplegia and uncontrolled urination and defecation. The condition had first appeared 2 years before as insidious thoracic spine pain with a progressive course; at that point, the patient was treated using traditional medicine. Thoracic computed tomography (CT) was conducted, and the results showed an intradural extramedullary calcified spinal tumour causing severe compression of the spinal cord at the level of thoracic vertebrae 8 (T8) and 9 (T9). Spinal magnetic resonance imaging (MRI) confirmed an intradural tumour at the T8 and T9 levels that was causing severe compression of the spinal cord. Total tumour resection was done using standard microsurgical techniques, and histopathological examination results confirmed the final diagnosis of meningioma. In conclusion, in cases like this, correct preoperative diagnosis and planning makes surgery easier and prevents neurological injury. Medical imaging using CT and MRI plays an essential role in this diagnosis and planning the management of ossified meningioma. Keywords Extramedullary . Intradural . Ossified meningioma . Paraplegia
Literature Review Meningioma is the most common non-glial primary tumour of the central nervous system, with an annual incidence of five in 100,000. According to the World Health Organization’s 2016 histological criteria, meningioma is usually a benign tumour. However, 15% are atypical, and 2% are anaplastic [1, 2]. Intradural spinal tumours are classified as either intramedullary or extramedullary, with the majority falling into the latter category. Schwannoma is the most common intradural spinal tumour, followed by meningioma [3]. Ossified meningioma is an extremely rare phenotype of metaplastic meningioma [4]. This article is part of the Topical Collection on Imaging * Sultan Abdulwadoud Alshoabi [email protected]
In recent decades, diagnosis of spinal tumours has improved, thanks to new imaging modalities. Computed tomography myelography (CTM) and magnetic resonance imaging (MRI) can easily detect and accurately determine the site of spinal tumours. MRI can determine the resectability and prognosis for spinal tumours [5], and it has to date been considered the best preoperative imaging modality for spinal tumours [6]. Management of intradural tumours depends more on their anatomical location than their clinical presentation or histological diagnosis. However, extramedullary tumours, which make up the majority, are easier to manage them [7]. In this study, we report on a rare case of intradural ossified meningi
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