Meningioma cervical intramedular: um relato de caso raro

Resumo

O meningioma intramedular é uma entidade relatada clinicamente de forma rara, tendo apenas nove relatos. Neste estudo, descrevemos o caso de um paciente masculino, 67 anos, com evolução de 25 anos, severos déficits motores, sensitivos e autonômicos. O diagnóstico foi confirmado por ressonância magnética mostrando uma massa intramedular central ao nível de C6-C7. O paciente foi submetido à microneurocirurgia com monitoração neurofisiológica, obtendo-se ressecção total e em bloco da lesão tumoral. Os achados histopatológicos e imuno-histoquímicos confirmaram meningioma angiomatoso com expressão multifocal de GFAP e de neurofilamento. O transoperatório ocorreu sem intercorrências, mas, quinze dias após, o paciente evoluiu com piora motora à esquerda. Apesar de extremamente raros, os meningiomas devem ser considerados um diagnóstico possível de tumoração intramedular.

Abstract

Intramedullary meningioma is a rarely reported clinical entity, with only 9 cases reported to date. We describe a male patient, 67 years old, with 25 years of evolution and severe motor, sensory, and autonomic deficits. Preoperative magnetic resonance imaging (MRI) showed an intramedullary mass at the C6-C7 level. The patient underwent microneurosurgery and neurophysiological monitoring confirmed total in bloc resection. The histopathological and immunohistochemical findings confirmed angiomatous meningioma with multifocal expression of glial fibrillary acidic protein (GFAP) and neurofilament. Trans-operative was uneventful and, fifteen days later, he evolved with motor worsening. Although extremely rare, meningiomas should be considered as eligible for intramedullary tumor diagnosis.

Palavras-Chave

meningiomas - intramedular - medula espinhal - relato de caso

Keywords

meningiomas - intramedullary - spinal cord - case report

• References

• 1 Salvati M, Artico M, Lunardi P, Gagliardi FM. Intramedullary meningioma: case report and review of the literature. Surg Neurol 1992; 37 (1) 42-45
• 2 Salehpour F, Zeinali A, Vahedi P, Halimi M. A rare case of intramedullary cervical spinal cord meningioma and review of the literature. Spinal Cord 2008; 46 (9) 648-650
• 3 Levy Jr WJ, Bay J, Dohn D. Spinal cord meningioma. J Neurosurg 1982; 57 (6) 804-812
• 4 Cushing H, Eisenhardt L. Meningiomas: Their Classification, Regional Behavior, Life History, and Surgical End Results. Springfield, Ill: Charles C Thomas; 1938: 735
• 5 Kim MS, Park SH, Park YM. Thoracic Intramedullary Clear Cell Meningioma. J Korean Neurosurg Soc 2006; 39: 389-392
• 6 Shuangshoti S, Netsky MG, Jane JA. Neoplasms of mixed mesenchymal and neuroepithelial type. With consideration of the relationship between meningioma and neurilemmoma. J Neurol Sci 1971; 14 (3) 277-291
• 7 Lyons M, Windgassen E, Kinney C, Johnson D, Birch B, Boucher O. Thoracic meningioma masquerading as chronic abdominal pain. Turk Neurosurg 2012; 22 (3) 365-367
• 8 Moriuchi S, Nakagawa H, Yamada M, Kadota T. Intramedullary spinal cord meningioma—a case report. Neurol Med Chir (Tokyo) 1996; 36 (12) 888-892
• 9 Epstein FJ, Farmer JP, Freed D. Adult intramedullary spinal cord ependymomas: the result of surgery in 38 patients. J Neurosurg 1993; 79 (2) 204-209
• 10 Tsai CY, Tsai TH, Lin CH, Cheng YH, Lieu AS. Unusual exophytic neurocytoma of thoracic spine mimicking meningioma: a case report and review of the literature. Eur Spine J 2011; 20 (Suppl. 02) S239-S242