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About Meningioma of spine
by anupam_phy, Feb 25, 2009 11:19AM
My aunt underwent a meningioma - D8-D10 laminectomy with removal of tumour by Professor S.N.Ghosh of Bangur Institute of Neurology on 5th December'08. Still she is bed ridden and unable to sit even without support. There seems to be no noticeable improvement. Pre operation, she was able to walk a few steps. But post operation, she even lost that. She is still using cathetere for urination. Post operation the MRI report says something like this:
1) Parameters:
FSE T1, T2 and STIR sagittal, FSE T2 weighted transverse images of the dorsal spine with slice thickness of 4 mm and 3 mm. Post contrast stuy also done after I.V. Gadodiamide.
2) Findings:
Changes are seen in posterior elements of D8,D9 and D10 vertebraeand in the adjoining soft tissues. Ill-defined diffuse enhacing lesion is seen on anterior and both lateral aspects of the epidural space at D9 to D10 level merging with the enhancing soft tissue at the surgical site posterioly. It is compressing the thecal sac and cord at D9-D10 level. There is hyperintensity in the cord at D8-D9 to D10-D11 level in T2 weighted images with mild hypointensity in T1 weighted images. Remaining cord and conus shows normal signal characteristics and conus is terminating at D12-L1 level.
Remaining dorsal vertebrae nd intervertebral discs show normal height, alignment and marrow signals without any abnormal enhancement.
No pre-vertebral and para-vertebral soft tissue mass is seen.
3) Impression:
The above findings are suggestive of post-operative change in the dorsal spine at D8 to D10 level with enhancing epirual soft tissue lesion in anterior and both lateral aspects of the spinal canal at D9-D10 level compressing the cord. There is also evidence of myelomalacia and gliosis in the cord at D8-D9 to D10-D11 levels.
On comparison with previous MRI dated 26.11.2008, there is decrease in the cord compression at D8 to D10 levels but alteration of cord signal is noted. Enhancing soft tissue in the epidural space at D9-D10 needs to be followed up to rule out residual lesion vs. post-operative granulation tissue in a follow up patient of meningiomal.
Suggested clinical correlation and further investigations if clinically indicated including follow up contrast enhanced MRI.
Please advice us on our next course of Action
Regards
Anupam
This discussion is related to What is myelomalacia?.
1) Parameters:
FSE T1, T2 and STIR sagittal, FSE T2 weighted transverse images of the dorsal spine with slice thickness of 4 mm and 3 mm. Post contrast stuy also done after I.V. Gadodiamide.
2) Findings:
Changes are seen in posterior elements of D8,D9 and D10 vertebraeand in the adjoining soft tissues. Ill-defined diffuse enhacing lesion is seen on anterior and both lateral aspects of the epidural space at D9 to D10 level merging with the enhancing soft tissue at the surgical site posterioly. It is compressing the thecal sac and cord at D9-D10 level. There is hyperintensity in the cord at D8-D9 to D10-D11 level in T2 weighted images with mild hypointensity in T1 weighted images. Remaining cord and conus shows normal signal characteristics and conus is terminating at D12-L1 level.
Remaining dorsal vertebrae nd intervertebral discs show normal height, alignment and marrow signals without any abnormal enhancement.
No pre-vertebral and para-vertebral soft tissue mass is seen.
3) Impression:
The above findings are suggestive of post-operative change in the dorsal spine at D8 to D10 level with enhancing epirual soft tissue lesion in anterior and both lateral aspects of the spinal canal at D9-D10 level compressing the cord. There is also evidence of myelomalacia and gliosis in the cord at D8-D9 to D10-D11 levels.
On comparison with previous MRI dated 26.11.2008, there is decrease in the cord compression at D8 to D10 levels but alteration of cord signal is noted. Enhancing soft tissue in the epidural space at D9-D10 needs to be followed up to rule out residual lesion vs. post-operative granulation tissue in a follow up patient of meningiomal.
Suggested clinical correlation and further investigations if clinically indicated including follow up contrast enhanced MRI.
Please advice us on our next course of Action
Regards
Anupam
This discussion is related to What is myelomalacia?.
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sorry to haer about the condition of your aunt.
But the good point is that she is still alive and living and remembering you. You should not forget that she has underwent a major tumor removal. Worsening of condition is normal after the removal. But it's less than 3 months of tumor removal. you an expect improvement in her condition till 6-9 months. Next course of action is "WAIT AND WATCH policy" as we don't have much option in our hands.
Please trust your doctor as he had done a great job and do appreciate that.
You are free to ask me more,
take care
regards
abhijeet