Dual-incision resection of multiple thoracic meningiomas presenting as lumbar stenosis: Case report

Spinal meningiomas are relatively rare. Multiple spinal meningomas causing symptomatic compression requiring surgery are extremely uncommon. The insidious presentation may delay clinical and surgical intervention. A 67-year-old diabetic patient with a remote history of prior thoracic spine tumor resections presented with worsening back pain radiating to both legs, bilateral lower extremity weakness, and gait disturbance. Lumbar MRI revealed severe lumbar stenosis. Prior history of tumor excision prompted a full spine MRI, revealing two large intradural extramedullary lesions. The patient underwent a posterior laminectomy and gross total resection of both lesions through separate incisions. Histopathology confirmed meningiomas. Postoperatively, the patient experienced improved neurological function. Patient is neurologically recovering well and is fully participating in physical therapy for post-surgical pain. The case highlights the importance of full-spine imaging in patients with prior surgical spinal procedures or when current symptoms are not entirely explained by current imaging. The surgical approach utilizing two separate incisions with separate laminectomies emphasized a less invasive strategy for multilevel tumor resection. This might be relevant to a patient with already extensive laminectomies. In patients with diabetes, additional suspicion should be raised for atypical presentations of surgical spinal pathology. This case highlights the need for routine surveillance in patients with prior spinal tumor excisions. This report adds to the literature by detailing neurosurgical planning and operative technique for a rare and potentially confounding clinical presentation. Case report. One patient presented to our clinical locations.