Spinal epidural en-plaque meningioma with an unusual pattern of calcification in a 14-year-old girl: case report and review of the literature.

A 14-year-old girl who presented with a severe sensory-motor-sphincter syndrome was found to be harboring an epidural tumor situated posteriorly in the spinal canal from C5 through C7 levels. The mass had computerized tomography and magnetic resonance imaging features suggesting an unusual stratified architecture, with a conspicuous highly calcific component firmly adherent to the dura and a non-calcific mass surrounding it posteriorly and laterally. Although meningiomas have a low incidence in the first two decades of life, and in the spine they rarely have entirely extradural location at any age, a meningioma was suspected. Intraoperative biopsy confirmed the tumor to be benign, and careful total resection including the whole large dural implant was carried out; the wide dural defect was grafted with fascia lata. A meningothelial meningioma with a largely calcified psammomatous component was diagnosed. The girl made a complete recovery, and is tumor-free 9 years postoperatively. Outcome from surgery for spinal meningiomas can be good, despite the severity of the preoperative condition; however, enplaque and highly calcific tumors still bear a poorer prognosis. Complete resection is mandatory in children, in whom they are extremely rare. Modern imaging techniques help in making a correct initial diagnosis and optimizing surgery in order to provide good results, even in more-challenging cases.