Paraplegia due to missed thoracic meningioma after lumbar spinal decompression surgery: A case report and review of the literature

Abstract

Spinal meningiomlar genellikle torakal seviyede localize olurlar ve kliniği kitlenin bulunduğu yere göre değişir. Çalışmamızda lomber spinal dekopresyon cerrahisi sırasında tespit edilmeyen ve paraplejiye sebep olan torakal spinal kord tümörü (meningioma) vakasını sunuyoruz. Hastada manyetik rezonans görüntüleme ile T2-3 düzeyinde torakal kitle saptandı. Hasta yeniden ameliyat edildi ve hastanın nörolojik semptomlar kısmen düzeldi. Cerrahlar, semptomsuz bir torakal menenjiomanın lomber spinal dekompresyon cerrahisi sonrası hastanın nörolojik semptomlarını şiddetlendirebileceğini bilmeleri ve ameliyat öncesi hastalarını bilgilendirmeleri gerekmektedir.

Keywords

• Lomber cerrahi, meningioma, torasik parapleji

Paraplegia due to missed thoracic meningioma after lumbar spinal decompression surgery: A case report and review of the literature

Abstract

Spinal meningiomas are often localized to the thoracic level and symptoms from a spinal meningioma are determined by the location of the mass. We present a case of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma) that was not detected during lumbar spinal decompressive surgery. Thoracic mass was detected in level of T2-3 on magnetic resonance imaging (MRI). The patient was re-operated and the patient's neurologic symptoms were partially relieved. Surgeons should know that a thoracic silent meningioma can aggrevate neurological symptoms after lumbar spinal decompression surgery and should inform their patient before surgery.

Keywords

• Lumbar surgery, meningioma, thoracic paraplegia

References

1. Whittle IR, Smith C, Navoo P, et al. Meningiomas. Lancet 2004;363:1535-1543.
2. Tomura N. imaging of tumors of the spine and spinal cord]. Nihon Igaku Hoshasen Gakkai Zasshi 2000; 60:302-311.
3. Covert S, Gandhi D, Goyal M, et al. Magnetic resonance imaging of intramedullary meningioma of the spinal cord: Case report and review of the literature. Can Assoc Radiol J 2003;54:177-180.
4. Salvati M, Artico M, Lunardi P, et al. Intramedullary menin- gioma: Case report and review of the literature. Surg Neu- rol 1992;37:42-45.
5. Yakut F, Özlu MM,Taşdemir N. Magnetic resonance imaging findings of redundant nerve roots syndrome. Dicle Med J 2012;39: 213-216.
6. Boccanera L, Laus M. Cauda equina syndrome following lumbar spinal stenosis surgery. Spine 1987;12:712-715.
7. Valls PL, Naul LG, Kanter SL. Paraplegia after a routine lumbar laminectomy: Report of a rare complication and successful man-agement. Neurosurgery 1990;27:638-640.
8. Turker RJ, Slack C, Regan Q. Thoracic paraplegia after lum- bar spinal surgery. J Spinal Disord 1995;8:195-200.

9. Takeuchi A, Miyamoto K, Hosoe H, et al. Thoracic paraple- gia due to missed thoracic compressive lesions after lum- bar spinal de-compression surgery. Report of three cases. J Neurosurg 2004;100:71-74.
10. Ciappetta P, Domenicucci M, Raco A. Spinal meningiomas: Prognosis and recovery factors in 22 cases with severe mo- tor defi-cits. Acta Neurol Scand 1988;77:27-30.
11. Bertrand G. The “battered” root problem. Orthop Clin North Am 1975;6:305-310.
12. Kostuik JP, Harrington I, Alexander D, et al. Cauda equina syndrome and lumbar disc herniation. J Bone Joint Surg Am 1986;68:386-391.
13. Ko SB, Lee SW, Shim JH. Paraplegia due to missed thorac- ic meningioma after laminotomy for lumbar spinal stenosis: Report of two cases. Asian Spine J 2011;5:253-257.
14. Marosi C, Hassler M, Roessler K, et al. Meningioma. Crit Rev Oncol Hematol 2008;67:153-171.