An Unusual Cervical Spinal Meningioma in a Child
A 14-year-old girl was admitted to our hospital in May 2012 due to right arm weakness and gait disturbance lasting for 2 weeks. She had also urinary incontinence. On general appearance, this patient looked healthy. Her neurological examination revealed right hemiparesis (Grade 2-3/4) that was more severe in the upper extremity than the lower and in the distal region than the proximal. The right biceps reflex, knee jerk, and ankle jerk were hyperactive. The Babinski sign was not found. There was no discernible sensory level.\nA magnetic resonance imaging (MRI) revealed an intradural extramedullary mass that was an isointense lesion on T1- and a slightly hyperintense on T2-weighted images, dorsal to the spinal cord in the level of C1. Spinal meningioma showed an intense enhancement on MRI after gadolinium administration ().\nSurgery was performed in the prone position. A rigid head holder, such as the skeletal fixation device, was used to secure the head in a neutral position. A laminectomy was performed with Kerrison punch at the C1 level. The dura mater was not tense. The operation was performed using a microsurgical technique. The dura was then opened straightly in the midline. A yellowish, hard tumor of oval shape was found immediately. The tumor was found to be intradural-extramedullary (). The thinned cervical cord was displaced laterally by the tumor. First, the central decompression of the tumor was done with the use of the ultrasonic surgical aspirator. The well-circumscribed, encapsulated tumor was separated easily from the surrounding tissue, allowing total excision. During the dissection, a major intradural vessel did not adhere to the tumor. After the tumor removal, hemostasis was obtained with warm saline irrigation and avitene hemostatic collagen. The dura was then closed primarily in a watertight fashion. The wounds were closed without tension.\nPostoperatively, the patient received systemic dexamethasone. Over the few days, her motor strength was markedly improved. The postoperative magnetic resonance study was done 2 days after the surgery (). Her neurological function had completely returned to its normal level at the time of discharge, 3 weeks after the surgery.\nThe histology examination of the tumor revealed that it was a meningotheliomatous meningioma. Individual tumor cells had indistinct cytoplasmic boundaries and nuclear clearing, cellular whorls, and psammoma body were noticed ().