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XXIV Congreso Nacional de la Sociedad Española de Neurocirugía
Madrid, 15-17 September 2021
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J. Esteban García, P. López Gómez, C. Santos Jiménez, D. Suárez Fernández, R. da Silva Freitas, P. de la Dehesa Cueto-Felgueroso, E.E. Arrojo Álvarez, M. Gómez Ruíz and R. Martín Láez

Neurocirugía, Hospital Universitario Marqués de Valdecilla. Santander, Spain.

Objectives: We present the unusual case of a lumbar nerve root meningioma. We show how despite these tumors are classically considered as benign lesions, they do not need to grow inside the skull to become a real challenge for multidisciplinary oncological teams.

Methods: A 56-year-old female patient came to our department complaining of continuous radicular pain with right L5 distribution. Lumbar MRI revealed an epidural foraminal L4-L5 dumbbell-shaped lesion with bony erosion.

Results: Laminectomy, decompression, macroscopic tumor resection and L5-S1 posterior fixation were performed. Histological report was a WHO grade II atypical meningioma. After initial clinical improvement and adjuvant radiotherapeutic treatment, our patient developed a progressive weakness on her right lower limb. A new MRI revealed tumor recurrence affecting vertebral body, L4, L5 and S1 roots. A two-stage procedure consisting of vertebrectomy supplemented with a lumbopelvic fixation was performed. Pathologists came to the same outcomes. All surgeries were assisted with intraoperative CT –scan navigation guidance optimizing tumor resection. Followed by a period of significant improvement, progressive paraparesis and cauda equina syndrome called for a new MRI that demonstrated an intrapelvic mass recurrence which required a multidisciplinary laparotomy. Just two months after tumor debulking, a surprising extremely aggressive tumor growth contraindicated the planned radiotherapeutic adjuvancy. The final diagnosis remained a WHO grade II atypical meningioma. In spite of our best efforts, the patient finally underwent palliative care.

Conclusions: Traditionally, spinal meningiomas have been a pleasant intervention for neurosurgeons because of their benign nature and their relatively easy cleavage plane. Nevertheless, sometimes surgical efforts against this disease are just palliative and non-curative surgeries. Grade II tumors are difficult to treat and require close follow-up. To our knowledge this aggressive behavior has never been described in an atypical lumbar meningioma. Further tumor characteristics than only the grade should be considered to fully understand this disease.

Neurocirugía (English edition)

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