Spinal meningioma

Jacob Young MD (Dr. Young of the University of California, San Francisco, has no relevant financial relationships to disclose.)
Nicholas Butowski MD (Dr. Butowski of the University of California, San Francisco, has no relevant financial relationships to disclose.)
Rimas V Lukas MD, editor. (Dr. Lukas has received honorariums from AstraZeneca as an advisory board member and AbbVie as a guest speaker.)
Originally released April 30, 1996; last updated November 12, 2017; expires November 12, 2020

Overview

Spinal meningioma is a rare tumor usually presenting with chronic progressive radicular or myelopathic symptoms and back pain. The authors discuss the clinical manifestations, diagnosis, and management of this tumor. Surgical resection is the treatment of choice for patients with neurologic deficits. Some patients may benefit from the radiosurgery for recurrent or partially resected spine tumors.

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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