[Transthoracic transvertebral approach for resection of an anteriorly located, calcified meningioma. Case report].
We report the case of a 61-year-old woman, who developed progressive paraparesia over a period of 8 months. Conventional X-rays of the thoracic spine showed an intra-spinal calcified lesion at T10. On CT-scan and MRI, the lesion appeared anterior to the cord, thus making a posterior approach hazardous. Total resection of this calcified meningioma was achieved through a right transthoracic transcorporeal approach, under close monitoring of the somatosensory evoked potentials. Despite a delayed pseudomeningocele formation requiring an additional thoracotomy, outcome after 7 years is excellent with no residual neurological deficit. No recurrence was seen on a CT-scan performed two years after the surgery. Calcified anterior meningiomas of the spine are rare lesions. Surgical outcome has been unfavorable for a long time in relation with posterior or postero-lateral approaches. Although anterior transthoracic procedures are routinely performed for extradural spinal lesions, this approach is rarely used for intradural lesions. A calcified anterior spinal thoracic meningioma should be managed like the more frequent calcified thoracic disk hernia, despite the increased risk of cerebrospinal fluid effusion requiring subsequent repair.
Jenny
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Service de Neurochirurgie, Hospital Cantonal Universitaire de Geneve, rue Micheli-du-Crest 24, CH-1211 Geneve 14, Suisse, France. benedict.rilliet@hcuge.ch
Rilliet
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May
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Pizzolato
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D002114:Calcinosis / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008579:Meningioma / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010264:Paraplegia / Q000209:etiology; D010292:Paresthesia / Q000209:etiology; D011183:Postoperative Complications / Q000601:surgery; D012120:Respiration Disorders / Q000209:etiology; D013125:Spinal Neoplasms / Q000150:complications / Q000601:surgery*; D013904:Thoracic Vertebrae; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed