Bisht Sneha, Laurente Raphael, Joshi K George
Department of Neurosurgery, Kathmandu University, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal.
Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
Surg Neurol Int. 2021 Mar 24;12:120. doi: 10.25259/SNI_869_2020. eCollection 2021.
Meningiomas are common intradural extramedullary spinal tumors with a predilection for the thoracic spine. They are mostly benign (90%), with only a few showing malignant potential. However, circumferential intradural meningiomas surrounding the spinal cord are exceptionally rare. Here, we present a 40-year-old patient with a T6-T7 circumferential lesion who underwent surgery. In addition, we reviewed three similar cases previously reported in the literature.
A 40-year-old female presented with paraparesis. Imaging demonstrated a T6-T7 thoracic circumferential intradural lesion, considered to most likely be a meningioma. At surgery, the posterolateral portion of the tumor was removed, but there was residual ventral disease. The tumor recurred several years later, and was again partially removed, now leaving her with a residual neurological deficit. Three similar cases of circumferential meningiomas, one cervical and two thoracic, were reported from the literature.
Circumferential meningiomas pose unique and significant surgical challenges, particularly since resection of the posterolateral components is feasible, but some tumor may have to be left ventrally to avoid injury to the anterior spinal artery, that may recur.
脑膜瘤是常见的硬脊膜内髓外脊髓肿瘤，好发于胸椎。它们大多为良性（90%），只有少数具有恶性潜能。然而，环绕脊髓的硬脊膜内周脑膜瘤极为罕见。在此，我们报告一例40岁接受手术治疗的T6 - T7节段周脑膜瘤患者。此外，我们回顾了文献中先前报道的三例类似病例。
一名40岁女性出现双下肢轻瘫。影像学检查显示T6 - T7节段胸椎硬脊膜内周病变，最可能为脑膜瘤。手术中，肿瘤后外侧部分被切除，但腹侧仍有残留病变。数年后肿瘤复发，再次部分切除，现患者遗留神经功能缺损。文献报道了三例类似的周脑膜瘤病例，一例为颈椎，两例为胸椎。
周脑膜瘤带来独特且重大的手术挑战，特别是因为切除后外侧部分是可行的，但为避免损伤可能会复发的脊髓前动脉，腹侧可能不得不残留部分肿瘤。
