Suga T, Nagayama T, Murakami E, Yoshioka K, Sano M, Goto H
Department of Neurosurgery, Kamaishi Municipal Hospital, Iwate, Japan.
No Shinkei Geka. 1996 Jun;24(6):567-72.
A case of a thoracic meningioma presenting paraplegia 4.5 years after removal of a falx meningioma is reported. A 73-year-old woman, complaining of diplopia, was admitted to our department. Neurological examination revealed right abducens palsy. CT demonstrated a well-enhanced right frontal mass beneath the falx. The mass was totally removed under right frontal craniotomy. Its histology was transitional meningioma with rich fibroblasts. 4.5 years after craniotomy, she complained of progressing gait disturbance and nocturnal leg pain. Neurological examination revealed paraplegia, complete loss of leg sensation, loss of patellar and ankle reflex, bilateral positive Babinski reflex and urinary disturbance. Rectal function and anal reflex were preserved. Thoracic MRI demonstrated an intradural extramedullary mass which was well enhanced with Gd-DTPA at Th6-7. Under laminectomy, the mass was totally removed. Its histology was transitional meningioma with rich psammoma bodies and whirl formations. 4 months after removal, her palsy and sensory loss were almost completely recovered. We were able to find 15 cases of combined intracranial and spinal meningiomas in the literature. A young woman of neurofibromatosis suffered from tentorial, intraventricular and C1-2 meningiomas. Of 15 cases without neurofibromatosis including our case, 4 cases were of young boys and 11 cases were of women. Their initial symptoms originated from intracranial meningiomas in 8 cases. Multiple intracranial meningiomas were revealed in only 4 cases. In 9 cases, one case presented a combination of one intracranial meningioma and one spinal meningioma. Histology of intracranial meningioma was almost the same that of spinal meningioma in almost half of the 10 cases. These findings suggest the multi sentricity theory of multiple meningiomas originating in other neuroaxial compartments. Severe spinal dysfunction was recovered after removal in our case. Rectal function and anal reflex were preserved. These anorectal findings suggest that spinal dysfunction is either complete or incomplete. Motor evoked potentials are hopeful tools which can select reversible spinal motor dysfunctions.
报告1例镰旁脑膜瘤切除术后4.5年出现截瘫的胸段脑膜瘤病例。一名73岁女性因复视入院。神经系统检查发现右侧展神经麻痹。CT显示镰下右侧额叶有一个强化良好的肿块。在右额开颅手术下将肿块完全切除。其组织学为富含成纤维细胞的过渡型脑膜瘤。开颅术后4.5年，她主诉步态障碍加重和夜间腿痛。神经系统检查发现截瘫、腿部感觉完全丧失、髌腱和跟腱反射消失、双侧巴宾斯基征阳性及排尿障碍。直肠功能和肛门反射保留。胸段MRI显示硬膜内髓外肿块，在T6 - 7水平经钆喷酸葡胺（Gd - DTPA）强化良好。在椎板切除术后，将肿块完全切除。其组织学为富含砂粒体和漩涡状结构的过渡型脑膜瘤。切除术后4个月，她的麻痹和感觉丧失几乎完全恢复。我们在文献中找到了15例颅内和脊髓联合脑膜瘤的病例。一名患有神经纤维瘤病的年轻女性患有小脑幕、脑室内及C1 - 2脑膜瘤。在包括我们病例在内的15例无神经纤维瘤病的病例中，4例为年轻男性，11例为女性。他们的初始症状有8例源于颅内脑膜瘤。仅4例发现有多发性颅内脑膜瘤。在9例中，1例表现为1个颅内脑膜瘤和1个脊髓脑膜瘤的组合。在10例中的近半数病例中，颅内脑膜瘤的组织学与脊髓脑膜瘤几乎相同。这些发现提示多发性脑膜瘤起源于其他神经轴隔室的多中心理论。在我们的病例中，切除术后严重的脊髓功能障碍得以恢复。直肠功能和肛门反射保留。这些肛肠检查结果表明脊髓功能障碍要么是完全性的，要么是不完全性的。运动诱发电位是有望用于选择可逆性脊髓运动功能障碍的工具。
