The English literature describes only four cases of intraspinal tumors requiring surgical intervention in the form of cordectomy; none of these cases was for meningiomas. Intraspinal meningiomas, typically extramedullary-intradural, require treatment in the form of resection with dural margin excision. The presentation of an intramedullary atypical World Health Organization grade II meningioma is rare. The authors report a case of a transformed intramedullary-extramedullary atypical meningioma treated with cordectomy.
The patient was a 65-year-old woman who presented with a recurrent thoracic meningioma status post three attempted resections, radiation therapy, and a trial of hydroxyurea chemotherapy. The patient presented paraplegic with reports of burning paresthesias bilaterally in her upper extremities 12 months after her third resection attempt.
Magnetic resonance imaging on this current presentation revealed a heterogeneously enhancing hypointense mass extending from T2 to T6. Extension of abnormal T2 signal within the cord superiorly to C7 was noted with a 1-cm enhancing extra-axial lesion at T10 and an extradural mass posteriorly T12 also noted. The patient underwent a T2-T7 laminectomy with a T2-T8 cordectomy. Two months postoperatively, the patient was doing well with no further deterioration in neurologic function.
This case highlights the viability of surgical cordectomy in the treatment of varying intramedullary processes under appropriate indications.