Treating Rare Cases of Spinal Meningioma Using Complex Surgical Tactics

Tanya: Last spring, I found myself in a place I never imagined I'd be: confined to a wheelchair, unable to walk, and faced with the terrifying possibility that I might never walk again. All I could think about was my daughter’s wedding in May. I dreamed of walking down the aisle, of dancing with my children. Doctor after doctor told me they could not find anything wrong. That was until I arrived at Baptist Health Miami Neuroscience Institute, where everything changed.

The happiest moment of my life came on my daughter’s wedding day when I not only walked but danced with both my son, Nick, and my daughter, Nicole. It felt like a miracle, and it was all thanks to what I now call my dream team—the incredible doctors, physician assistants, nurses, and everyone else at the Institute who cared for me.

The Onset of My Symptoms

I’m 50 years old, and just over a year ago, I began losing feeling in my toes. At first, I didn’t think much of it, then the numbness spread to my feet, and over the following months, it crept up my legs to my hips. It wasn’t just numbness—sometimes cramps shot through my legs. Gradually, I lost my balance and started falling. I had to stop driving. I even became incontinent. For someone who had been a lifelong athlete, who went to college on a softball scholarship, it was like watching my life unravel.

The progression was terrifying. I went from using a cane to a walker, and finally, I ended up in a wheelchair. Despite all the imaging studies and MRIs doctors performed on my spine, no one could figure out what was wrong. They knew I had surgery at 15 to correct scoliosis, with metal rods, screws and hooks placed in my spine, but they didn’t believe it was the cause of my condition. I had lost hope.

A New Approach

Then, I met Dr. Richard Morgan, a physiatrist at Baptist Health Miami Neuroscience Institute who specializes in physical medicine and rehabilitation. By the time I saw him, I’d already gone through countless tests with specialists outside of Baptist Health. Dr. Morgan had a different approach.

Robert Rothrock, MD

Dr. Morgan suspected that the metal in my spine was creating “noise” in the MRI images, making it difficult to see what was really going on with my spinal cord. He ordered a test no one else had thought of—a CT myelogram, which uses contrast dye and X-rays to get a detailed look at the spinal cord and the surrounding tissues.

On April 1, I underwent the CT myelogram, and the results were conclusive—there were two large masses compressing my spine. The moment they were found, Dr. Morgan and Dr. Robert Rothrock, a neurosurgeon and the director of Spinal Oncology at Baptist Health Miami Neuroscience Institute, were contacted immediately. That same day, I was admitted into Baptist Health Hospital, and two days later, on April 3, I was in surgery.

Understanding My Diagnosis

The diagnosis was spinal meningioma—typically slow-growing benign tumors that form in the protective membranes around the brain and spinal cord. They are more common in women, and though the exact cause isn’t always clear, Dr. Rothrock believed the radiation exposure as a child for my scoliosis treatment likely contributed to it.

"In this case, the preoperative diagnosis was based on the imaging findings on the CT myelogram,” Rothrock told NeurologyLive. "The presence of a calcified intradural extramedullary mass lesion is highly suggestive of underlying diagnosis of spinal meningioma, and generally speaking, this type of finding is considered pathognomonic of this tumoral entity. However, without the CT myelogram, preoperative diagnosis would have been near impossible in this case."

When these tumors are small, they often cause no symptoms, but mine had grown large enough to compress my spinal cord, causing the debilitating symptoms I was experiencing. If left untreated, I could have ended up permanently dependent on urinary catheters, diapers, and confined to a wheelchair or bed. It could have even led to my death or permanent loss of function.

Rothrock added, "In general, spinal meningioma is a rare clinical disease entity. The estimated age-adjusted incidence is approximately 0.193 per 100,000 individuals. Due to the specialized nature of our program, however, this is a clinical diagnosis that we see on a weekly basis."

A Complex and Life-Saving Surgery

The surgery was complicated. Not only did the doctors remove the tumors, but they also had to take out the titanium rods, hooks and screws that had been in my spine for over 30 years, which had become overgrown with bone. One of the tumors was calcified, meaning they had to drill it out. It was a difficult procedure, but I was in the best hands.

"The surgical intervention in this case was highly complex and occurred in 5 main stages," Rothrock added. "Stage I was surgical exposure including cranial caudal exposure of the pre-existing spinal hardware. Stage II was removal of the pre-existing 7 mm thick stainless-steel rods and hooks and pre-existing scoliosis hardware, in conjunction with revision laminectomies through 2 cm thick of overgrown bone in the setting of previous scoliosis correction. Stage III was intradural tumor resection in 2 separate areas, including the need to drill highly calcified tumor in the region of the patient's spinal cord."

He continued, "Stage IV was surgical reconstruction of the dura, requiring patch allograft and reconstruction of the damaged dura from the presence of the calcified tumoral lesion. And finally, stage V was surgical reapproximation of the complex wound in conjunction with plastic surgery with multiple indwelling drains. The success of the surgical operation was due to the team-based approach- including our complex spinal surgery team with dedicated circulating nurses, surgical technologists, radiology technologists, multiple neurosurgeons, plastic surgeon, and a fully dedicated and optimized operative environment."

Dr. Rothrock was joined by Dr. Michael McDermott, chief medical executive of Baptist Health Miami Neuroscience Institute, and about 30 other surgical assistants, technologists, pathologists, and anesthesiologists. It felt like an entire city was working to save my life. The surgery was successful and I knew the road to recovery would be long.

"The key factor immediately postoperatively was to ensure the entirety of the two separate tumoral areas had in fact been removed. This was then verified on postoperative MRI scan, which was made feasible by the removal of the pre-existing hardware in the region of the tumor resection," Rothrock said. "Otherwise, the patient was kept head of bed flat for the first 48 hours following the surgical procedure given the complex dural reconstruction and the need to offset tension on the dural graft and closure. The patient was then immediately mobilized around 48 to 72 hours postoperatively in conjunction with physical therapy. Given the patient's inability to ambulate preoperatively, the patient still required a prolonged and supervised postoperative recovery rehabilitation period."

A Family’s Strength

I spent a month in the hospital, followed by several weeks at an inpatient rehabilitation center. During this time, my wife, Marite de Cespedes, was my rock. She never left my side, and my family was there for me every step of the way. They were my strength, the reason I kept going even when I felt I couldn’t do it anymore.

Just a week before my daughter’s wedding, I returned home and continued my physical therapy to build my strength for the trip. When the wedding day finally arrived, I walked down the aisle with my son. When it came time to dance, it was more of a shuffle than anything else, but it was a moment I had dreamed of, and it had become a reality.

Looking Toward the Future

Now, as I prepare for my son’s wedding, I feel incredibly grateful for the second chance I’ve been given. Thanks to the Baptist Health Miami Neuroscience Institute, I have my life back. After the wedding, I’m planning to travel again. I want to see waterfalls, visit new places, put on my hiking boots and get them dirty again.

My recovery has been nothing short of miraculous. In a field like neurosurgery, where there are so many unknowns, I know how lucky I am. As Dr. Rothrock said, "No one wants to go to war, but there are wars worth fighting.” I am so glad I fought this one, and am eternally grateful to my medical team and family for standing by my side.

Every day I wake up, I’m reminded of the miracle that was given to me, and I’m determined to make the most of this second chance at life.