Sacral extradural spinal meningioma with recurrence; a case report

Extradural spinal meningiomas are very uncommon, and just a scattering of clinical reports on this condition have been published. Despite being benign, epidural meningiomas exhibit a higher recurrence rate compared to typical meningiomas. In this case report, we described a case of sacral extradural spinal meningioma with several episodes of recurrence and discussed the clinical characteristics, radiological features, and management, along with follow-up details. A 19-year-old woman with back discomfort and lower extremity numbness. Magnetic resonance imaging (MRI) revealed a tumor on the left posterolateral S1–S2 spinal cord. L5–S3 hemilaminectomy and foraminotomy were performed. After three years, the patient had bilateral L4–S1 laminectomy and radiotherapy for tumor recurrence. Two years later, the patient presented with pain and paresthesia in the lower limbs and was diagnosed with a tumor recurrence once more. Due to sacral area adhesion from earlier surgeries and radiation, the patient received CyberKnife radiation instead of tumor resection. No complaints or signs of recurrence were detected during follow-up examinations. Extradural spinal meningiomas are uncommon and can occasionally be misidentified as malignant metastatic tumors both before and during surgery. This misclassification could potentially lead to alterations in the recommended surgical approach. Although epidural spinal meningiomas are often benign, their long-term prognosis is uncertain, and the recurrence rate is higher than ordinary meningiomas. Hence, lengthy monitoring is necessary to identify any recurrence risk (like our case).