Thoracic spine intra- and extradural dumbbell-shaped meningioma: Case report and extensive review of the literature with 21 cases

Introduction

Spinal dumbbell-shaped meningioma is a rare condition usually mistaken preoperatively for schwannoma. The present study reported a case of dumbbell-shaped meningioma, with an extensive review of literature.

Methods

A documented case of thoracic spine dumbbell-shaped meningioma is reported, followed by an extensive review of the literature to analyze epidemiological features, pathogenesis, histopathological diagnosis, location, Eden classification, surgical treatment and outcome in such tumors.

Results

Case report: A 55 year-old woman was admitted with paraparesis and paresthesia of lower limbs. MRI showed a dumbbell-shaped meningioma of the thoracic spine. The tumor was totally removed via a posterolateral approach.

Review of the literature

Twenty-one spinal dumbbell-shaped meningiomas were reported in the last twenty years (1997–2017). Mean patient age was 46.57 years, with female predominance. Mean disease progression was 23.11 months. The thoracic spine was the predominant site (38.09%), followed by the cervical spine (33.33%). Eden type-3 was the most frequent tumor type, accounting for 66.67% of cases. In all cases, meningiomas were classified as WHO grade I. Complete removal (Simpson I–II) was achieved in 75% of cases. There was recurrence in 3 patients (14%), including 1 case of malignant transformation leading to death at 12 years post-surgery.

Conclusion

Spinal dumbbell-shaped meningioma is mainly of the benign subtype. Long-term follow-up shows low rates of morbidity and mortality.