History & Physical: This is a 47-year-old female who presents with a 2-year history of numbness in bilateral lower extremities. Her symptoms began in the toes and have progressed proximally to her trunk, currently located as a band-like area of numbness under her bra. She has a 3-month history of intermittent spasticity that lasts 2-3 seconds and is associated with loss of balance. She denies any bowel or bladder dysfunction, upper extremity or other neurological symptoms. She gained 15 pounds from steroids used to treat her environmental allergies and was diagnosed with thoracic outlet syndrome in the past, although no imaging studies were performed then. Her past medical history also includes transient hyperthyroidism, resolving over 20 years ago, but still monitored with TSH levels.
Imaging: MRI examination showed an intradural, extramedullary circumscribed mass that enhanced.
1. The diagnosis of this lesion is most likely:
2. The treatment option of choice in this patient is:
3. The optimal surgical approach to this lesion would be:
4. The optimal surgical option offered to this patient would be:
5. Adjunctive treatments offered would include:
6. The follow-up of this patient would include:
7. Please provide any comments or suggestions regarding management of this case:
"Dural tail and lesion is typical for tspine meningioma, I would watch postop before any adjuvant therapy"
"Hyperthyroidism should be investigated. (Pituitary hormone level) Cranial and spinal (lower thorocal) MRI should be done and tumor receptors can be necessary."
"I think the pathologic diagnosis should be presented in the result."
"Watch with plain films to rule out acquired instability."
"follow-up frequency depends on tumor pathology"
"the axial cut MRI is not very clear"
"Pretty straightforward. Might use SSEP monitoring intraoperatively."