Microsurgical Excision of Multiple Clear Cell Meningiomas of the Cauda Equina: A Case Report

Abstract

We report the case of a 21-year-old woman who presented with a 2-year history of worsening radicular pain on the right leg. The Valsalvamanoeuvre provoked radicular pain and radiography showed right-convex 36 ° scoliosis. Examination showed slight hypoesthesia on the right L3-S1 dermatomes but abnormal muscle power and reflexes. Magnetic resonance imaging identified cauda equina tumours at the L2-3 and L4 levels. The tumours showed heterogeneously isointense signals on T₁-weighted image, hypointense signals on T₂-weighted image, and hyperintense signal on gadolinium-enhanced T₁-weighted sequences. The tumour was microsurgically extirpated from the cauda equina and resected through multiple small laminotomies. Macroscopically, the tumours were poorly encapsulated, hard in consistency, adherent to the adjacent cauda equinas, irregularly shaped like a “horseradish”, and yellowish-grey in colour. Histopathological diagnosis was clear cell meningioma.

Key words

cauda equina - clear cell meningioma - microsurgery - immunohistochemistry

References

• 1 Scheithauer BW. Tumors of meninges: proposed modifications of the World Health Organization classification.  Acta Neuropathol. 1990;  80 343-354
• 2 Alameda F, Lloreta J, Ferrer MD. et al . Clear cell meningioma of the lumbo-sacral spine with chordoid features.  Ultrastruct Pathol. 1999;  23 51-58
• 3 Heth JA, Kirby P, Menezes AH. Intraspinal familial clear cell meningioma in a mother and child.  J Neurosurg. 2000;  93 317-321
• 4 Park HC, Sohn MJ, Kim EY. et al . Spinal clear cell meningioma presented with progressive paraparesis in infancy.  Child's Nerv Syst. 2000;  16 607-610
• 5 Epstein NE, Drexler S, Schneider J. Clear cell meningioma of the cauda equina in an adult: case report and literature review.  J Spinal Disord Tech. 2005;  18 539-543
• 6 Founier D, Mercier P, Pouplard F. et al . Invasive character of an intradural spinal meningioma in early childhood.  Childs Nerv Syst. 1993;  9 28-32
• 7 Oviedo A, Pang D, Zovickian J. et al . Clear cell meningioma: case report and review of the literature.  Pediatr Dev Pathol. 2005;  8 386-390
• 8 Holtman RNN, Jormark SC. Nondural-based lumbar clear cell meningioma.  J Neurosurg. 1996;  84 264-266
• 9 Payano M, Kondo Y, Kashima K. et al . Two cases of nondura-based clear cell meningioma of the cauda equina. Case report.  APMIS. 2004;  112 141-147
• 10 Zorludemir S, Scheithauer BW, Hirose T. et al . Clear cell meningioma: a clinicopathologic study of a potentially aggressive variant of meningioma.  Am J Surg Pathol. 1995;  19 493-505
• 11 Pimentel J, Fernandes A, Pinto AE. et al . Clear cell meningioma variant and clinical aggressiveness.  Clin Neuropathol. 1998;  17 141-146
• 12 Jallo GI, Kothbauer KF, Silvera VM. et al . Intraspinal clear cell meningioma: diagnosis and management: report of two cases.  Neurosurgery. 2001;  48 218-222
• 13 Dubois A, Sévery A, Boetto S. et al . Clear-cell meningioma of the cauda equina.  Neuroradiology. 1998;  40 743-747
• 14 Florman J, Khoshyomn S, Tranmer B. Intraspinal clear cell meningioma: diagnosis and management-report of two cases.  Neurosurgery. 2001;  49 481
• 15 Matsui H, Kanamori M, Abe Y. et al . Multifocal clear cell meningioma in the spine: a case report.  Neurosurg Rev. 1998;  21 171-173
• 16 Carrá S, Drigo P, Gardiman M. et al . Clear-cell meningioma in a 22-month-old male: a case report and literature review.  Pediatr Neurosurg. 2001;  34 264-267
• 17 Prinz M, Patt S, Mitrovics T. et al . Clear cell meningioma: report of a single case.  Gen Diagn Pathol. 1996;  141 261-267

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