Cervical Spine Inhomogeneously Enhancing Lesion: Avoiding Confirmation Bias

Confirmation bias is the tendency to seek information and evidence in order to confirm a preexisting hypothesis while giving less importance and overlook an alternative solution. This report describes the case of a 52-year-old man with a long history of neck pain and bilateral upper limbs paresthesias with a cervical intracanal inhomogeneously enhancing lesion. Despite all the preoperative radiological findings, a spinal meningioma an anterior approach was performed. The mass ended up being a large migrated hernia with the involvement of two levels. Before suggesting treatment, especially surgery, physicians and practitioners need to evaluate all of the possible alternatives in order to optimize patient outcome.

Health-Related Quality of Life and Return to Work after Surgery for Spinal Meningioma: A Population-Based Cohort Study

Spinal meningiomas are the most common primary spinal intradural tumor. This study aimed to assess Health-related quality of life (HRQoL) and the frequency of return to work in patients surgically treated for spinal meningiomas, in comparison to the general population. Variables were collected from patient charts, EQ-5D-3L, and study specific questionnaires. Patients who had been operated between 2005–2017 were identified in a previous study and those alive in 2020 (104 of 129) were asked to participate. Eighty-four patients (80.8%) with a mean follow-up of 8.7 years, responded and were included. Data was compared to the Stockholm Public Health Survey 2006, a cross-sectional survey of a representative sample of the general population. Analysis for potential non-response bias showed no significant differences. Women in the meningioma sample scored more problems than men with regards to mobility (p = 0.048). There were no significant differences concerning EQ-5Dindex (p = 0.325) or EQVAS (p = 0.116). The correlation between follow-up time and EQ-5Dindex was low (r = 0.167). When comparing HRQoL to the general population sample, no significant differences were found within the EQ-5D-3L dimensions, EQ-5Dindex or EQVAS. Those who postoperatively scored 3–5 on mMCs scored significantly more problems in the EQ-5D-3L dimension mobility (p = 0.023). Before surgery, 41 (48.8%) of the spinal meningioma patients were working and after surgery all returned to work, the majority within three months. Seventy-eight (96%) of the patients would accept surgery for the same diagnosis if asked today. We conclude that surgery for spinal meningiomas is associated with good long-term HRQoL and a high frequency of return to work.

Simultaneous trigonal and spinal meningioma with varied histology: A rare case report

Background: Meningioma is one of the most common neoplasms of the central nervous system. Multiple meningiomas without neurofibromatosis are not a usual occurrence. Intraventricular meningioma with spinal meningioma is rare and not been reported in the literature. Case Description: We report a case of a 63-year-old male with the left trigonal and spinal meningioma. Both the meningiomas were resected in different settings. The histological examination of tumors revealed to be of varied histology, that is, meningothelial and atypical meningioma, respectively. Conclusion: Although various cases with multiple cranial and spinal meningiomas are described, this is the first case of an intraventricular and spinal meningioma. With varied histology, the case also reaffirms the theory of polyclonal origin of multiple meningiomas.

Thoracic meningioma with ossification: Case report

Background: The incidence of spinal meningiomas is 0.33/100000 population, and ossified spinal meningiomas are even less commonly encountered. Case Description: A 64-year-old male presented with a progressive T4-level thoracic myelopathy. MR imaging revealed an intradural extramedullary mass that significantly compressed the spinal cord. The accompanying CT demonstrated hyperdensities within the lesion consistent with punctate calcification vs. ossification (i.e. consistent with histological bone formations within tumor). The patient underwent complete resection of the tumor resulting in a full recovery of neurological function within 6 postoperative weeks. The pathological specimen showed findings consistent with an ossified spinal meningioma. Conclusion: Here, we identified a rare case of an ossified thoracic T4 meningioma occurring in a 64-year-old male.

SPASTIC PARAPARESIS IN YOUNG MEN WITH SPINAL MENINGIOMA AND SPINAL ARTERIOVENOUS MALFORMATION: A CASE REPORT

Background: Compared to trauma cases, the publication of non-traumatic events is much less, although the incidence is estimated to be as much as a traumatic event. This case report presents spinal cord tumors together with arteriovenous malformation (AVM) in young men, where there are no previous case reports that the authors can find.Case Report: A 22-year-old male patient with complaints of pain in the back (NPRS 8-9), followed by difficulty moving the lower limb accompanied by a burning sensation, problem in defecation, and urination. We found motor weakness in the lower extremities (1/1), positive pathological reflexes, and sensibility disorders on physical examination.Discussion: According to history taking, physical examination, and MR Imaging, the spastic paraparesis symptom in this patient is likely due to a spinal cord tumor, which is meningioma (according to histopathological examination). Where back pain rarely presents in the patient with spinal AVM. Laminectomy and tumor destruction were the gold standards of therapy, and the symptom was relieved.Conclusion: A complete examination is the main key in determining the appropriate therapy for the patient's disease. In this case, the manifestation of spastic paraparesis was likely to be caused by meningioma rather than spinal AVM. Laminectomy and extirpation of the spinal meningioma were done as the gold standard of therapy, and the symptom was relieved. In contrast, spinal AVM was not performed­ and is still under observation.

Cervical intra-extradural meningioma with en-plaque, dumbbell-shaped, and an unusual calcified pattern in a young patient

Background: Most spinal meningiomas primarily grow in the intradural extramedullary location. Epidural meningiomas are uncommon; if detected, they usually coexist with intradural lesions. They inhere more aggressive and invasive characteristics compared with their counterparts inside the dura. Case Description: We report a 22-year-old female who was admitted to the hospital with weakness and numbness in both lower limbs. Her cervical magnetic resonance imaging revealed an en-plaque and dumbbell-shaped lesion located from C5 to C8. After gadolinium injection, the whole mass was enhanced and unveiled two portions: intradural and extradural. The bone window of the computed tomography scan revealed calcification inside the lesion. The patient underwent tumor removal surgery. The pathology findings showed a psammomatous meningioma. After 6 months of surgery, the patient has been able to walk with walkers. Conclusion: We should consider spinal meningioma as a differential diagnosis when encountering an extradural lesion in the cervical region. The optimal surgical treatment for young patient with epidural meningiomas is radical surgery with dura attachment removal.