ABSTRACT
Objective:
To present a new case of an ossified spinal meningioma which is extremely uncommon patology, gives a sense of a real cancellous bone in surgery and to emphasize the importance of the physical shape of the tumor during the surgery.
CUnical presentation:
A 63-years-old woman was complaining about progressive symmetrical weakness and numbness of lower extremities for about three years and had urinary incontinence over two months. Neurological examination revealed an incomplete paraplegia. Both patella and Achilles reflexes were hyperactive, a positive Babinski’s sign and Achilles clonuses were also present. The muscle tone of lower extremities was increased. The cervicodorsal MRI showed a hypo intense mass lesion both on T1 and T2-weighted images between the spinal levels of T1 and T4. This lesion had the maximal thickness at the level of T2 and T3 and caused a thin myelopathic signal. The dorsal CT scan with sagittal reconstruction revealed that the lesion had the same density with the bone.
Method: Total:
laminectomies were performed at the first four dorsal vertebrae. The dura overlying the tumor was very hard and invaded by it. The sense of dura was like leaves of bamboo which are hard and longitudinally oriented. Although not easy, the dura could be detached from the tumor by a micro dissector. It was relatively easy to dissect the tumor from the spinal cord because; it was not so adherent unlike its dural attachment. The tumor was totally removed with the invaded parts of the dura which then was closed by an allogreft. Postoperatively, the patient was complete paraplegic. Pathologic examination of the tumor revealed psammomatous meningioma with osseous metaplasia.
Conclusion:
Ossified meningiomas are very rare tumors. This metaplasia can complicate the surgery and affect the surgical outcome. If predicted preoperatively, the CT scan, especially with reconstruction can show the exact shape of the tumor. This knowledge can be very useful during surgery, especially providing information about the counteracting moves remote from the microscopic field.
