Intraspinal clear cell meningioma: diagnosis and management: report of two cases.

Abstract

Intraspinal clear cell meningioma is a rare morphological variant of meningioma. Only 13 case reports are found in the literature; therefore, no management strategy has been defined for this tumor type. This article describes two patients, reviews the literature, and proposes a treatment plan for clear cell meningioma. Two female patients, 22 months and 8 years of age, respectively, presented with localized neck and leg pain that limited their ability to walk. Magnetic resonance imaging revealed intradural tumors, a cervical intramedullary neoplasm in the younger patient, and a cauda equina tumor in the older child. Both patients underwent radical resection of their intradural tumor. Both tumors, however, recurred shortly (5 and 6 mo) after the initial operation. During the second operation, a radical removal was performed on each patient. Both patients received adjuvant radiotherapy. In addition, the younger patient developed posterior fossa metastasis 20 months after intraspinal surgery. Intraspinal clear cell meningiomas are very uncommon tumors. The clinical course in our two patients supports the reported 40% recurrence rate within 15 months. These tumors also can disseminate within the central nervous system. We recommend serial imaging studies every 3 months. For recurrent tumors, we recommend localized radiation therapy after reoperation.