Background and Importance In the field of spinal tumors, and in particular among extra-axial spinal and peripheral nerve tumors, the occurrence of dumbbell lumbar meningioma has not been reported in the literature. In the present study we describe a case of a patient suffering from dumbbell-shaped lumbar meningioma. This tumor resulted, after postoperative histological examination, a fibroblastic meningioma, WHO I grade, a very rare entity. Dumbbell meningiomas are extremely uncommon, comprising only 2–3.6 %. Clinical Presentation An 81-year-old man presented with history of gradually increasing lumbar pain, not related with decubitus and axial load, and right sciatica for 6 months. Another clinical feature was sensitive and motor (4/5 BMRCI) deficits at level of right L5 radicular territory. MRI shows a dumbell lesion in right neuroforamen L5-S1. With the patient in a prone position, we exposed and excised the tumor via a one stage posterolateral approach, through a hemi-laminictomy of L5, starting from a midline lumbar right L5-S1 interlaminar approach, extended to far lateral right articular and extra-articular region. We pre-operatively assumed the mass was a schwannoma because of its location and dumbbell shape, and planned the surgical procedure with use of continuous intraoperative neurophysiological neuromonitoring, to minimize the concrete risk of a possible intraoperative neurologic damage and preoperative neurological deficits worsening. Patient did not develop more deficits and the tumor resulted a fibroblastic meningioma. Patient recovered upright posture and walking during the first postoperative day, with the aid of a lumbar corset. The surgical wound was regular and subfascial lumbar drainage was removed on the first postoperative day. During postoperative recovery no additional neurological deficits appare and the low back pain and the right sciatic pain partially improved. On the fifth postoperative day patient was discharged from the hospital with the indications to wait for the histological examination result for any possible subsequent terapie and for the appropriate follow-up. Conclusion This patient-case report suggests that dumbbell shape of a spinal tumor (in particular at level of lumbar spine) has to be underwent to a very careful differential diagnosis, considering the possibility to discover, among the most frequent histology neoplastic lesions, the presence of histologically more rare tumors. This knowledge is very important from the beginning of surgical and therapeutic planning to the diagnostic and possible postoperative adiuvant therapeutic follow-up of patient.
Subcutaneous phaeohyphomycosis caused by Bipolaris hawaiiensis: a case report