Spinal-thoracic dumbbell meningioma: a case report.

STUDY

DESIGN

Total excision of a large dumbbell cervicothoracic intra- and extraspinal meningioma that had grown into the posterior mediastinum is described. This excision involved a two-step neurosurgical-thoracosurgical procedure within a short interval.

OBJECTIVES

To document that the described laminectomy and thoracotomy techniques are adequate, safe, and effective for the treatment of this intra- and extraspinal meningioma lesion.

SUMMARY OF BACKGROUND DATA: The management of intra- and extraspinal dumbbell tumors is based on anecdotal reports of mostly neurinomas, and thus remains a controversial issue. Even large series of spinal meningiomas lack adequate information on how best to treat large cervicothoracic meningiomas.

METHODS

The authors have modified standard techniques used for resection of spinal and mediastinal tumors, respectively, adapting them for a large, invasive dumbbell meningioma in a 72-year-old lady. The patient initially underwent laminectomy and microsurgical excision of the intraspinal tumor portions encasing vascular structures. A week thereafter, a thoracotomy was performed, and the mediastinal tumor portions were removed completely.

RESULTS

Restitution was remarkably good. The patient, who had been unable to walk on her own, regained some mobility. At this writing, she was able to walk considerable distances without support. There was no evidence of tumor recurrence during a follow-up interval of 3 years.

CONCLUSIONS

The authors recommend a two-staged procedure for complete excision of a large spinal-thoracic meningioma. Even in elderly patients with major neurologic deficits, an impressive recovery can be achieved with such lesions.