Primary spinal meningioma in a 10-year-old boy

. Meningiomas are largely benign in nature and their recurrence is most associated to histologic type. The current treatment of choice is surgical resection.The aim of this report is to present a case of a ten year-old boy diagnosed with a psammomatous meningioma in the topog-raphy of the thoracic column (T4), and to review some epidemiological, pathophysi-ological, clinical and prognostic features.CaseA ten year-old male patient with no relevant past medical history sudden-ly showed progressive spastic parapare-sis of lower limbs with reduced sensitiv-ity to pain, 40 days prior to hospital ad-mission. Moreover, no infections had been observed prior to symptoms, nor relevant epidemiological antecedents or previous exposure to ionising radiation. Clinical ex-amination revealed bilateral reduction in muscular strenght of the legs and thighs (both power grade II) with normal bilat-eral deep tendon reflexes while no chang-es in sensitivity to heat, pain or proprio-ception were observed. The results of der-matologic examination were normal. Fun-doscopy was normal. The child also had normal CSF tests. Brain CT scan showed no signs of schwannomas or other tumors. A neuroaxis MR (Fig 1) showed a poste-rior intradural expansive mass at the lev-el of T4 and T5 vertebrae, in an appar-ent extra-medullary, well delimited, ho-mogenous, lobulated topography. The tu-mor measured around 1.8 × 1.2 × 0.9 cm and was characterized by T1 iso-signal, T2 hypersignal, and homogenous accentuat-ed enhancement following contrast injec-tion, and exerted a local expansive effect creating medullar dorsal compression with signs of local edema/trauma signs charac-terized by T2 hypersignal. The patient un-derwent laminectomy, and opening up of the dura exposed a whitish tumor com-pressing the adjacent medulla. The tumor presented a hard consistency, with little bleeding, a clear cleavage plane with the dura mater and weak adherences to the adjacent arachnoid. The tumor was ful-ly resected. Anatomopathologic study re-vealed a psammomatous meningioma (Fig 2). Post-operative evolution was satisfac-tory, with recovery of muscular strength to power grade 4 in three days. He is cur-rently undergoing motor rehabilitation with good clinical evolution.DisCussionMeningiomas are rare tumors in chil-dren, accounting for less than 5% of brain tumors in children and less than 2% of all