Cervical Dumbbell Meningioma Exhibiting Distinct Histopathological Subtypes in Intradural and Extradural Components: A Case Report

Background Spinal dumbbell meningiomas are rare, accounting for only 4–5% of all spinal meningiomas. To our best knowledge, no case report has documented different histological subtypes within separate anatomical components of the same tumour. The presence of histological heterogeneity between the intradural and extraforaminal regions is a novel finding and has important implications for surgical planning and prognosis. We present here a rare case of cervical dumbbell-shaped meningioma with distinct histological subtypes in the intraspinal and extraforaminal components. Case presentation: A 57-year-old man presented with progressive myelopathy and radiculopathy, including weakness and numbness of the left thumb and index finger, bilateral hyperreflexia, spasticity, unsteady gait, and increased deep tendon reflex. Magnetic resonance imaging revealed a gadolinium-enhancing dumbbell-shaped tumour at the C5/6 level with a dural tail sign, consistent with Eden type III spinal dumbbell tumours. The patient underwent two-stage microsurgical excision: initial posterior laminotomy and laminoplasty of C4–C6 with left C5/6 facetectomy for intradural tumour removal followed by extraforaminal resection using a ventrolateral approach 6 months later. Histopathological examination revealed a transitional meningioma in the intradural compartment and a fibrous meningioma in the extraforaminal component. The intradural tumour was soft and rubbery, whereas the extraforaminal portion was firm and adhered to surrounding structures. The patient achieved complete neurological recovery with no complications or tumour recurrence at the 6-year follow-up visit. To our best knowledge, this is the first case of a distinct meningioma subtype in separate anatomical compartments of a dumbbell-shaped cervical meningioma. Conclusions Dumbbell cervical meningiomas can present with exceptional histopathological heterogeneity, with distinct transitional and fibrous subtypes identified in the intradural and extraforaminal components, respectively. The excellent long-term outcomes achieved with a tailored two-stage surgical approach highlight the importance of individualised strategies for treating these rare and complex lesions. Recognising the potential histological diversity of dumbbell-shaped meningiomas is essential for effective surgical planning and optimisation of patient outcomes.