title: An atypical spinal meningioma with CSF metastasis: fatal progression despite aggressive treatment. Case report.
abstract: The authors report the case of a 23-year-old man who presented with a C1-3 spinal mass. Following intraspinal decompression the tumor was histologically classified as an atypical meningioma (World Health Organization grade II). Two further surgical interventions resulted in almost total removal of the meningioma. In addition, radiotherapy was performed. During the 1.5-year follow-up period the diagnostic examinations identified a local tumor recurrence, an intraspinal C-6 metastasis, and a segmental instability with anterior C2-3 slippage and C3-4 kyphosis. The tumor was resected and occipitocervical stabilization was performed. Histological examination showed no change in malignancy. Despite additional hydroxyurea-based chemotherapy, the patient presented 4 months later with a hemiparesis and a massive recurrence of the tumor mass involving the posterior fossa and the upper thoracic spine. Because there were no further therapeutical options, the patient died. The authors discuss more aggressive therapeutic options in addition to surgery in patients with metastatic atypical meningiomas. The results in the reported case indicate that meningiomas associated with cerebrospinal fluid metastasis may represent a higher grade of malignancy.
authors.affiliation: Department of Neurosurgery, Charité, Campus Virchow-Medical Center, Medical School of Berlin, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Cramer
authors.forename: Ulrich-Wilhelm
authors.initials: UW
authors.lastname: Thomale
authors.forename: Ali Fuat
authors.initials: AF
authors.lastname: Okuducu
authors.forename: Arne J
authors.initials: AJ
authors.lastname: Lemke
authors.forename: Florian
authors.initials: F
authors.lastname: Stockhammer
authors.forename: Christian
authors.initials: C
authors.lastname: Woiciechowsky
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae; D019299:Decompression, Surgical; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D007593:Joint Instability / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D008579:Meningioma / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D009192:Myelography; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000009:adverse effects; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D013120:Spinal Cord Neoplasms / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D013122:Spinal Diseases / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents; D006918:Hydroxyurea