The application of surgical cordectomy in the management of an intramedullary-extramedullary atypical meningioma: Case report and literature review

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: This case highlights the viability of surgical cordectomy in the treatment of varying intramedullary processes under appropriate indications.