外傷性脊髄損傷を契機に診断にいたった小児脊髄異型性髄膜腫の1例

抄録

  Spinal atypical meningiomas in pediatric patients are very rare, and no consensus exists regarding their characteristics, treatment, and prognosis. We report a case of this type of tumor in a 16-year-old boy who had experienced a gradual decline in muscle strength for several years and developed sudden quadriplegia after falling down the stairs. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a homogeneously enhanced tumor with calcifications inside the spinal canal at C2 level, and the tumor was firmly compressing the spinal cord. Intraoperative findings revealed that the tumor was highly calcified, but there was no spinal cord invasion. Since it was an emergency, tumor resection was performed after initial preservation of adjacent roots, access to the attachment site ventrolaterally after debulking, and precise dissection through a well-defined plane from the medulla, achieving Simpson grade II resection. Histopathological examination revealed that most of the findings were consistent with meningothelial meningioma; however, some features of atypical meningioma were present, and the MIB-1 index was 11.2%. Therefore, the lesion was considered an atypical meningioma. Two years after the surgery, there was no recurrence. Because of its pathological grade and no excision of the attachment dura, careful follow-up is required.