Cervical dumbbell meningioma exhibiting distinct histopathological subtypes in intradural and extradural components: a case report

Spinal dumbbell meningiomas are rare, accounting for only 4–5% of all spinal meningiomas. Histological heterogeneity within the same dumbbell lesion is even rarer, with all previously reported cases involving coexistence of a meningioma with either a schwannoma or a neurofibroma. To our knowledge, this is the first report of distinct meningioma subtypes occurring in separate anatomical compartments of a single dumbbell-shaped meningioma, a novel finding with important implications for surgical planning and outcomes. A 57-year-old man presented with progressive myelopathy and radiculopathy, including weakness and numbness of the left thumb and index finger, bilateral hyperreflexia, spasticity, and unsteady gait. Magnetic resonance imaging revealed a gadolinium-enhancing dumbbell-shaped tumour at the C5/6 level with a dural tail sign, consistent with an Eden type III spinal dumbbell tumour. The patient underwent two-stage microsurgical excision: initial posterior laminotomy and laminoplasty of C4–C6 with left C5/6 facetectomy for intradural tumour removal, followed by extraforaminal resection using a ventrolateral approach. Histopathology confirmed transitional and fibrous meningioma subtypes in the intradural and extraforaminal components, respectively. No fusion was performed after facetectomy, as postoperative alignment remained stable. Delayed C5–6 spondylolisthesis developed 2.5 years later and was successfully managed with cervical artificial disc replacement, restoring alignment and preserving motion. The patient achieved full neurological recovery with no recurrence at six-year follow-up. Dumbbell cervical meningiomas can present with exceptional histopathological heterogeneity, with distinct transitional and fibrous subtypes identified in the intradural and extraforaminal components, respectively. The excellent long-term outcomes achieved with a tailored two-stage surgical approach highlight the importance of individualised strategies for treating these rare and complex lesions. Recognising the potential histological diversity of dumbbell-shaped meningiomas is essential for effective surgical planning and optimisation of patient outcomes. This is the first reported case of a cervical dumbbell meningioma exhibiting two distinct WHO grade I subtypes—transitional and fibrous—located in separate anatomical compartments of a single tumour. A two-stage microsurgical strategy, combining a posterior approach followed by ventrolateral resection, achieved gross-total resection while preserving neurological function. The patient achieved complete neurological recovery and has remained disease-free for six years after surgery.