Myelopathy due to calcified meningiomas of the thoracic spine: minimum 3-year follow-up after surgical treatment

Presented at the 2012 Joint Spine Section Meeting 

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Object

Calcified meningiomas are an uncommon type of meningioma. This study details the clinical features, treatment, and follow-up of 11 calcified meningiomas treated from 2002 to 2009, for the purpose of providing general information, describing the skill required for the surgery, and detailing the imaging study of these tumors.

Methods

Between 2002 and 2009, 11 patients underwent surgery for the treatment of calcified meningiomas. All were treated by the same group of doctors at the same institution, including surgery and rehabilitation after surgery. The minimum 3-year (> 36 months) follow-up data from the 11 patients were detailed. Neurological function was evaluated twice, based on the Frankel scale and Japanese Orthopaedic Association scoring system. The first evaluation occurred before surgery and the second 3 years after surgery.

Results

In 3 cases, the Frankel score decreased by 1 level. In a comparison of the duration of preoperative symptoms, age, degree of canal stenosis, and intraoperative blood loss, it was found that the greater the degree of canal stenosis, the poorer the outcome of the patient. Calcified meningiomas were more likely to adhere to the nerves and dura, a finding that might explain the high incidence of neurological dysfunction and CSF leakage after surgery.

Conclusions

Calcified meningiomas are the most rare of all meningiomas. It appears that a greater degree of canal stenosis can lead to a poorer outcome. Computed tomography scans and MRI with contrast enhancement are recommended for intraspinal tumors before surgery to exclude the possibility of calcification. For calcified meningiomas, precise tumor resection, dura repair during surgery, and medical care after surgery are important for achieving an acceptable outcome.

Abbreviation used in this paper:JOA = Japanese Orthopaedic Association.

Article Information

Address correspondence to: Jianru Xiao, M.D., Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China. email: jianruxiao83@163.com.

Please include this information when citing this paper: published online March 15, 2013; DOI: 10.3171/2013.2.SPINE12609.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 5. Images obtained in a 73-year-old woman with a T4–5 calcified meningioma. A: Sagittal MR image showing a mass with low signal intensity. B: Sagittal MR image showing the same mass with enhancement after injection of intravenous contrast material. C and D: Sagittal (C) and coronal (D) 2D reconstructed CT scans demonstrating that the mass was calcified only at the base.

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    Case 8. Images obtained in a 65-year-old woman, in which all the tumor was calcified; therefore, complete resection was required. The sagittal 2D reconstructed CT scan (A), sagittal MR image (B), and axial MR image (C) all show a heterogeneous mass.

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    Case 10. Sagittal (right) and axial (left) MR images obtained in a 56-year-old man. This meningioma was calcified only at the base, was adherent to the dura, and was resected piecemeal; the calcified part was resected last.

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    Sagittal (A), coronal (B), and axial (C) MR images showing enhanced masses after injection of intravenous contrast material.

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    Case 2. Images obtained in a 57-year-old woman with a meningioma at T5–7. A: Sagittal MR image showing a mass enhanced after injection of intravenous contrast material. B: Axial CT scan demonstrating calcification of the mass. C–E: Sagittal 2D reconstructed CT scan (C), axial CT scan (D), and axial MR image (E) obtained after surgery demonstrating fusion.

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    Photomicrographs of tissue obtained from Case 2 (left) and Case 9 (right) showing calcification. H & E, original magnification ×100.

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    Photographs of removed calcified meningiomas. Left: Tumor removed in Case 10, a 56-year-old man. The meningioma was calcified only at the base, adhered to the dura, and was resected in a piecemeal fashion, with the calcified part resected last. Right: Tumor removed in Case 8, a 65-year-old woman. The entire tumor was calcified; thus complete resection was required.

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