Abstract:Meningiomas are among the commonest primary extramedullary spinal neoplasms (Broager, 1953; Lombardi and Passerini, 1961) and they are most frequently encountered in the dorsal region (Sloof, Kernohan, and McCarty, 1964).
The most common histological entities among the spinal intradural extramedullary tumors are nerve sheet tumors (neurinomas) followed by meningiomas. The spinal group of menigiomas constitute approximately for 7.5–12.7 % of all meningiomas. More than 60 % of all spinal meningiomas are located in the thoracic spine. 86–95 % of the tumors are found intradurally.
Although the frequency of meningioma among primary spinal cord tumors is 25 %. multiple spinal cord meningiomas are extremely rare. Multiple spinal cord meningiomas have not been reported in the spinal cord meningioma series of A. Davis (45 patients), K. Katz (44 patients), Lombardi and Pasarini (71patients) and by Haft and Shenkin (367patients). (1-3.5.7.9).
Walter J. Levy and his colleagues and F. Carta et al. have reported respectively two multiple spinal cord meningiomas among patients who had spinal cord meningiomas. Single cases of multiple spinal meningiomas have been described by Rand, Rath et al. and Di Rocco et al. Only Rath and his colleagues reported multiple meningiomas, which were intradural thoracic and extradural cervical. (2, 4, 8.10, 14, 19, 22, 34, 45, 48, 55, 60-61)
Meningiomas usually arise within the dura; in some cases they can extend beyond it, but are rarely extradural in toto (Rasmussen, Kemohan, and Adson, 1940). When, however, this does occur; spinal meningiomas share with other predominantly extradural neoplasms, notably neurofibromas, a tendency to extend through adjacent intervertebral foramina into the thorax (Heuer, 1929; Naffziger and Brown, 1933). According to Bull (1953) and Gautier-Smith (1967), bony radiological changes are rare with meningiomas but common with neurofibromas, thus providing a valuable criterion for their differential diagnosis. The occurrence of multiple meningiomas in different neuraxial compartments is rather rare. (12-16, 19, 33, 45, 58-61).
Comparatively similar to cranial meningiomas, the main risk factors for the spinal group are ionizing radiation, genetic predisposition, and female gender. (4-9, 11-18, 22, 60)
CT scan without and with contrast and MRI scans, including T1and T2-weighted images, with and without contrast are the usual diagnostic methods. They show spheric contrast-enhancing structures with extra- and intradural, intra- and extra-medullar localizations. The tumor matrix is typically in a lateral position. Sometimes it is difficult to differentiate meningiomas from neurinomas in the rare cases when meningiomas grow intra- and extradurally (dumbbell tumors). Distinct calcifications, which can be recognized in computed tomography, suggest a meningioma. Larger cystic areas rather indicate a neurinoma. (10, 19-23, 25-33, 56, 58-61)
The aimed treatment of spinal meningiomas is usually the total surgical excision of the tumor with assistance of neuronavigation, using of intraoperative ultrasound (for ideal tumor localization) and intraoperative neuromonitoring (for functional observation and preservation).
For the surgical intervention, a dorsal approach is preferred, except for few cases, in which sometimes lateral extension is indicated by partial resection of the facettal joint or the head of rib in the region of the thoracic spine.
Postoperatively, the majority of patients have satisfactory outcomes. Advances in radiologic and surgical techniques such as computed tomography (CT), magnetic resonance imaging (MRI), intraoperative ultrasound, evoked responses, ultrasonic aspirators and lasers have brought about better clinical results. However, the meningioma may re-occur, especially as a result of incomplete resection. The goal of surgical treatment must be total resection ,if possible. Total resection of a spinal meningioma is usually possible, but if the tumor is ventral to the cord and calcified, surgery becomes hazardous and may damage the cord. The operative and long-term mortality rates of spinal meningioma have decreased recently. (24, 34-44, 57, 59, 61)
The purpose of this article is an update of this disease based on a literature review and the own experience with case illustration. Additionally, the most recent own consecutive case series is collected and presented between 2008 and 2012.
Keywords:Spinal meningioma, spinal tumor, psammomatous bodies, dumbbell tumor.
Title: SPINAL MENINGIOMAS: ILLUSTRATION / EVALUATION OF OWN DATA AND REVIEW OF THE LITERATURE
Author: Munthir Al-Zabin, Ullrich Reichenhoff
ISSN 2394-966X
International Journal of Novel Research in Life Sciences
Novelty Journals