Thoracic ossified meningioma and osteoporotic burst fracture: treatment with combined vertebroplasty and laminectomy without instrumentation

Case report

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✓ Although spinal meningioma is a common benign neoplasm, the ossified variant is rare. No more than 20 sporadic cases were reported in the literature between 1977 and January 2005. Recently, the authors treated a patient with a symptomatic ossified meningioma located in the posterior aspect of T-11 and an associated osteoporotic T-11 burst fracture. The tumor was completely removed by T10–11 laminectomy and transpedicular vertebroplasty was performed. The kyphotic deformity of the T-11 burst fracture was partially reduced and maintained for at least 2 months after vertebroplasty and laminectomy. The clinical presentation and management of this case are reported.

Abbreviations used in this paper: MR = magnetic resonance; VB = vertebral body.

Article Information

Address reprint requests to: Cheng-Chih Liao, M.D., Chang Gung University and Chang Gung Memorial Hospital, 5, Fu-shing Street, 333 Kweishan, Taoyuan, Taiwan. email: liao2901@adm.cgmh.org.tw.

© AANS, except where prohibited by US copyright law.

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Figures

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    Plain radiographs. A: Preoperative supine x-ray film demonstrating a T-11 acute osteoporotic burst fracture with a cleft of vacuum phenomenon (white arrowhead). B: Supine radiograph acquired 2 months after the combined surgical procedure revealing that the VB heights of both T-10 and T-11 (black arrowhead) were maintained. C: Sitting lateral radiograph obtained 2 years postoperatively, demonstrating well-preserved T-11 VB height (arrow) but an adjacent T-10 compression fracture.

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    Magnetic resonance imaging studies. A and B: Preoperative spinal MR images revealing a hypointense intraspinal tumor behind the T-11 burst fracture (arrow) on both sagittal (A) and axial (B) T2-weighted MR images. C: Follow-up T2-weighted MR image obtained 2 months postoperatively, showing a well-preserved T-11 VB height without tumor recurrence, but subclinical cord impingement. D: Two years after surgery, an adjacent T-10 compression fracture developed and caused more severe cord impingement, which remained clinically asymptomatic.

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    Intraoperative photographs (A and B) and a photomicrograph (C). A: After T10–12 laminectomy and durotomy, a tumor (arrowhead) is observed to the left of the spinal cord. B: A whitish, round, and stony-hard lesion with a diameter of approximately 1 cm is seen. C: Tissue composition of woven bone with sparse psammoma bodies and foci of tumor cells displaying the pattern of meningothelial meningioma. H & E, original magnification × 200.

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