Four patients with extradural spinal meningiomas are reported; one had
relapsing neurological deficits in two postpartal periods. In a bibliographic
review of 35 cases, nearly as many extradural spinal meningiomas occurred
in men as in women, five were in children, and three were lumbar or lum-
bosacral neoplasms in men.
S
PINAL MENINGIOMAS usually become tions stained with hematoxylin and eosin
evident clinically as intradural, ex- showed a neoplasm composed of cells with
tramedullary neoplasms at the thoracic moderate cytoplasm and oval vesicular
level in middle-aged women. 4,7,16,2~ We are nuclei, arranged in sheets and whorls. There
reporting four patients with extradural spinal were small numbers of psammoma bodies
meningiomas. These cases and those found (Fig. 1). One year after surgery the patient
on bibliographic review represent interest- walked unsupported, and managed her home
ing variants of the more common in- without help.
tradural spinal meningiomas.
Case 2
Case Reports A 54-year-old man had had back pain ra-
Case 1 diating down the back of his legs for 10
A 40-year-old woman had had progres- months and urinary incontinence for 4
sive paraparesis for 5 years, and for 1 year months, which had not been relieved by re-
had had left flank and thigh pain unrelieved moval of a lumbar intervertebral disc at an-
by a lumbar laminectomy. On admission to other hospital. On admission, examination
the North Carolina Baptist Hospital she was showed the pain to be reproduced during
unable to walk, incontinent of urine and motion, back percussion, and leg-raising.
feces, had hypalgesia below T-8, hyperactive There was atrophy of the left anterior tibial
knee and ankle stretch reflexes, and extensor muscles, hypalgesia of S-2 and the lower sa-
plantar responses. A myelogram showed a cral segments, and absence of the left knee
subarachnoid block at "I"-5. Laminectomy re- and ankle reflexes. The plantar reflexes were
vealed a red extradural tumor at T-4 com- normal. The myelogram showed a complete
.pressing the dura on the left. It was removed block at the L-5 vertebral body. Laminec-
m pieces with its dural attachment; a pea- tomy of L-3, -4, -5 revealed a red, beefy
sized intradural component was present. Sec- mass in the extradural space at L-5 invading
Fie. 4. Case 4. Photomicrographs of tumor at first operation showing sheets of polygonal cells, some
in whorls. Left: Intradural mass. H & E, 100. Center: Extradural mass. H & E, 100. Right: Me-
ningioma removed from posterior mediastinum. H & E, 100
TABLE 1
Summary of 35 cases of extraduralspinalmeningioma
Vertebral
Author, Year Age Sex Level Comment
meningiomas because of our doubt as to the Although many authors mention a definite
correct diagnosis. ~,24,31 incidence of extradural spinal meningiomas,
the problem has received little emphasis. As
General Deductions in our series Henschen 17 also had four extra-
P r i m a r y t u m o r s in the spinal c a n a l are un- dural tumors among 20 spinal meningiomas.
c o m m o n . M e n i n g i o m a s p r o b a b l y o c c u r sec- Most authors have reported a smaller propor-
ond in f r e q u e n c y to n e u r i l e m o m a s 2 4 B o t h in tion of extradural meningiomas, and we be-
o u r series a n d others, 8 0 % of the patients lieve the figure of about 15% by Sloof, e t al., 34
with spinal m e n i n g i o m a s have been w o m e n , to be near the true incidence.
a n d the age of the patients has a v e r a g e d 48 Many series and case reports were
years.4,r,16,z0,34,38 searched to find the cases in Table 1. There-