Thoracic meningioma presenting with progressive lower paraparesis in a female patient in her 30’s

Abstract

The most common tumors located in the thoracic segment of the spinal cord are spinal meningiomas and schwannomas. Meningiomas arising from the sheaths of the spinal cord represent about 20% of all benign tumors of the spinal canal. Second place is occupied by metastases, which mainly aff ect bone structures and much less often – the spinal cord. Meningiomas are predominantly intradural extramedullary tumor formations, although some rare cases of extradural spinal meningiomas have been described in the literature. The World Health Organization divides these tumors into three grades according to their malignancy, which include 15 histological subtypes of meningiomas with a predominantly benign course of development. The psammomatous meningioma belongs to grade I with a benign course and its total extirpation leads to a good ten-year tumor control. Meningiomas are typically slow-growing tumors that commonly present clinically after the fifth decade of life, with a higher prevalence in female patients. The occurrence of thoracic meningiomas in younger individuals, particularly in the second and third decades is often associated with neurofibromatosis. In this report, we describe a female patient in her 30’s with a one-year history of back pain radiating along the ribs, accompanied by progressive lower limb weakness and sensory disturbances over the past 30 days. The clinical complaints and the performed imaging diagnostics show the presence of an intradural, extramedullary tumor formation located at the level of TH5-TH6 vertebral projections and occupying more than 60% of the spinal canal. The treatment consists in total tumor extirpation by means of microneurosurgical technique and histological verifi cation of the process. Subsequent radiotherapy for resected Simpson grade II spinal meningiomas and for psamoma variant of meningioma is not recommended. Clinical monitoring using magnetic resonance imaging is the gold standard for controlling tumor growth.