Spinal meningioma

Zubair A Shaikh MD (Dr. Shaikh of Mid Michigan Medical Center has no relevant financial relationships to disclose.)
Edward J Dropcho MD, editor. (Dr. Dropcho of Indiana University Medical Center has no relevant financial relationships to disclose.)
Originally released April 30, 1996; last updated March 20, 2009; expires March 20, 2012
Notice: This article has expired and is therefore not available for CME credit.

Overview

Spinal meningioma is a rare tumor usually presenting with chronic progressive radicular or myelopathic symptoms and back painThe author discusses the clinical manifestations, diagnosis, and management of this tumor. Some patients may benefit from the Cyberknife® Radiosurgery System for recurrent or partially resected spine tumors. However, surgical resection remains the treatment of choice even in older patients with severe neurologic deficits.

Historical note and terminology

In 1887 Horsley performed the first reported successful removal of an intradural, extramedullary tumor (Gowers and Horsley 1888). With the support of Sir William Gowers, Horsley removed a "fibromyxoma" overlying the spinal cord at the T4 level. Postoperatively, the patient developed a debilitating pain syndrome, but later experienced a full neurologic recovery. In the following 50 years, pioneering neurosurgeons such as Elsberg, Frazier, and Cushing took particular interest in extramedullary tumors, recognizing their frequently benign nature and often dramatic recovery from profound neurologic deficit (Frazier 1918; Elsberg 1925; Cushing and Eisenhardt 1938). The term "meningioma" was introduced by Cushing in his 1922 Cavendish lecture as a simple designation and is now universally employed. With the development of modern imaging, neuroanesthesia, and microsurgical techniques, Cushing's description of "one of the most gratifying of all operative procedures" is now the expected in most patients with intradural, extramedullary spinal tumors such as meningiomas (Nittner 1976; Levy et al 1982; Boccardo et al 1985; Levy et al 1986; Champion and Brophy 1987; Solerno et al 1989).

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