J Korean Soc Spine Surg.  2012 Jun;19(2):72-76. 10.4184/jkss.2012.19.2.72.

Ossified Meningioma: A Case Report

• Ahn DK
• Moon SH
• Lee S
• Kim TW
• Kim J
• Hong SW
• Kim DG

• KMID: 2209560
• DOI: http://doi.org/10.4184/jkss.2012.19.2.72

Abstract

STUDY DESIGN: A case report
OBJECTIVES
To report an extremely rare case of the spinal meningioma containing bone. SUMMARY OF LITERATURE REVIEW: Spinal meningiomas represent 16.6-46.7% of the primary spinal tumors and 1 to 5% of them are calcified. Ossification is an extremely uncommon event that complicates the resection surgery.
MATERIALS AND METHODS
We experienced a 59-year-old patient who complained of weakness in the lower limbs and gait disturbance. Spinal cord compressing mass was discovered on a MRI at T6 and there was a vertical plate at the posterior side of the mass. Surgical finding showed complete ossification in the dural attachment site of the mass. Though the tumor mass could be excised with the inner layer of the dura mater en masse, more forceful retraction of the spinal cord was unavoidable than the other soft mass resection.
RESULTS
The preoperative neurological impairment improved after the surgery and she was able to walk well.
CONCLUSIONS
Ossification makes a resection difficult and vulnerable to develop neurological deterioration. But if we could suspect such an ossification through an image test, it would be helpful to make a surgical plan to avert a neurologic complication.

Keyword

Meningioma; Ossification; Spinal tumor

MeSH Terms

Dura Mater
Gait
Humans
Lower Extremity
Meningioma
Middle Aged
Spinal Cord

Figure

• 

  Fig. 1. Preoperative MRI revealed solid intradural, extramedullary tumor measuring 1cm in diameter located at the level of T6 spinal canal. Ovoid mass was compressing the spinal cord. The lesion showed mixed intensity on the T1-weighted image and hypointensity on the T2-weighted image. On the dis-tal posterior aspect of tumor, there was a plate-shaped lesion like a tail on T1 and T2-weighted images(arrow). The gadolinium-enhanced image showed homogeneous enhancement. (A) T1-weighted sagittal (B) T2-weighted sagittal (C) Enhanced sagittal (D) T2-weighted axial.

• 

  Fig. 2. Intraoperative photography showed well marginated 1.0×0.8×0.7cm-sized yellowish - red soft tissue mass containing plate-shaped mature woven bone(arrow).

• 

  Fig. 3. Histologic finding showed mixed pattern or intermediate features of meningothelial and fibrous meningiomas. In the lower part of this his-tologic feature, mature lamellar bone formation was shown(H&E, ×40).

• 

  Fig. 4. Photomicrograph showing characteristic concentric meningeal whorls(H&E, ×100).

Reference

1.Naderi S., Yilmaz M., Canda T., Acar U. Ossified thoracic spinal meningioma in childhood: a case report and review of the literature. Clin Neurol Neurosurg. 2001. 103:247–9.

2.Doita M., Harada T., Nishida K., Marui T., Kurosaka M., Yoshiya S. Recurrent calcified spinal meningioma detected by plain radiograph. Spine (Phila Pa 1976). 2001. 26:E249–52.

3.Niijima K., Huang YP., Malis LI., Sachdev VP. Ossified spinal meningioma en plaque. Spine (Phila Pa 1976). 1993. 18:2340–3.

4.Saito T., Arizono T., Maeda T., Terada K., Iwamoto Y. A novel technique for surgical resection of spinal meningioma. Spine (Phila Pa 1976). 2001. 26:1805–8.

5.Rogers L. A spinal meningioma containing bone. J Br Surg. 1928. 15:675–7.

6.Freidberg SR. Removal of an ossified ventral thoracic meningioma. Case report. J Neurosurg. 1972. 37:728–30.

7.Levy WJ Jr., Bay J., Dohn D. Spinal cord meningioma. J Neurosurg. 1982. 57:804–12.

8.Roux FX., Nataf F., Pinaudeau M., Borne G., Devaux B., Meder JF. Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeu-tic management. Surg Neurol. 1996. 46:458–64.

9.Kubota T., Sato K., Yamamoto S., Hirano A. Ultrastructural study of the formation of psammoma bodies in fibroblastic meningioma. J Neurosurg. 1984. 60:512–7.

10.Huang TY., Kochi M., Kuratsu J., Ushio Y. Intraspinal os-teogenic meningioma: report of a case. J Formos Med As-soc. 1999. 98:218–21.