Cranio-Cervical Junction Meningioma: A Rare Case Report Volume 4 - Issue 5

Sukriti Das¹*, Asit Chandra Sarker¹, Dipankar Ghosh¹, Kanji Fatema Ishrat Zahan¹, Mohammed Shamsul Islam Khan¹, Akhlaque Hossain Khan² and Bipin Chaurasia³

• ¹Department of Neurosurgery, Dhaka Medical College & Hospital, Bangladesh
• ²Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Bangladesh
• ³Department of Neurosurgery, Tarai Hospital and research centre, Birgunj, Nepal

Received: November 06, 2020;   Published: November 30, 2020

Corresponding author: Sukriti Das, Associate Professor, Department of Neurosurgery, Dhaka Medical College & Hospital, , Dhaka, Bangladesh

DOI: 10.32474/OJNBD.2020.04.000198

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Abstract

Background: Meningioma is a benign and slowly growing intradural extramedullary spinal cord tumor. It arises from the arachnoid cap cell of the meninges. Meningioma of the cranio-cervical junction is a rare and unique diagnosis of about 1.8-3.2% of all meningiomas. These tumors usually grow slowly and develop symptoms gradually but, sometimes with sudden onset of quadriplegia. The lesions are usually very large at the time of diagnosis. Post-surgical tumor recurrence is high due to failure of complete removal of the tumor (Simpson grade-I) as critical vascular structures, brainstem and cranial nerves are close to it.

Case Report: We presented a case of a cranio-cervical junction meningioma of a 45-year-old female who presented with neck pain with headache and gradual weakness of all 4 limbs that made her unable to walk without support and bed-ridden gradually. She also developed urinary incontinence and was catheterized. On examination, the patient was conscious and alert, muscle power was of MRC grade 0/5 in all groups of muscles in all 4 limbs. All deep tendon reflexes were exaggerated in both upper and lower limbs with positive Hoffmann sign bilaterally and bilateral planter extensor response. All modalities of sensations were diminished up to C₄ vertebral level. MRI of cervical spine was obtained, and the diagnosis of cranio-cervical junction meningioma came out.

Conclusion: After complete surgical removal (Simpson grade I) of the tumor, post-operative ICU management is very vital. Extubation and recovery may need long time to return to normal life. So pre-operative counseling and post-operative ICU support is mandatory to operate cranio-cervical junction meningioma.

Keywords: Cranio-Cervical Junction; Meningioma; Intradural-Extramedullary; Simpson Grade; Gross Total Removal

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