Meningioma

Spinal meningiomas are classically intradural extramedullary tumors that arise from arachnoid cap cells in close proximity to the dentate ligaments. They have a higher incidence in women and generally affect middle-aged people. They are associated with neurofibromatosis type 2 as well as a history of radiation therapy for unrelated pathologies. They most commonly occupy the antero-lateral compartment of the spinal canal and are predominantly found in the thoracic spine. Diagnosis is often delayed due to slow growth and non-specific presenting complaints. Symptoms of neurologic compression develop when a critical degree of stenosis is reached and are characterized by gait, sensory, and sphincter disturbances. The diagnostic imaging modality of choice is MRI with and without gadolinium, which classically demonstrates a pathognomonic dural tail. Computed tomography imaging is also useful to assess the degree of calcification of the tumor. Surgical approach is usually posterior with laminectomy or laminoplasty. The lesion is localized with intraoperative ultrasound and the surgical microscope and microsurgical techniques are implemented for resection. Surgical outcomes are generally very good with low peri-operative morbidity and mortality and excellent neurologic recovery is typical. The tumors are histologically benign in most cases, and radical resection, including excision of the dural base, offers the highest probability of durable oncological cure. Adjunctive radiosurgery is reserved for more aggressive histological grades or recurrent lesions. Alternative chemotherapeutic options are in their infancy of development.