The patient came to the clinic 30-July-2007 complaining of inability to walk for 7 months with rapid deterioration, starting from the right the the left lower limb within one month. She is in wheelchair for 7 months. MRI performed 11-March-2007 showed a huge meningioma at D2-3 level.

On examination: the patient had complete spastic paraplegia with severe rigidity and scissoring of the lower limbs with exaggerated deep reflexes and bilateral Babinski and massive clonus and spastic rigidity, making the limbs unable to put them apart. The patient claim that she can feel the lower limbs, but position sense is impaired and she could not know, which toe of which foot the examiner is pinching. Defecation and micturition was normal, as she claimed, but she was in wet diaper and she was from Yemen and it was hard to tell the actual condition. The patient was sent for another MRI, which confirmed the presence of large meningioma at the mentioned levels.

Laminectomy of D2-3 and flavotomy of D1-2 and D3-4 was performed. The dura was opened from the right side. The tumor was rubbery dense and the running roots of D2 and D3 were dissected of the tumor. Piecemeal resection of the tumor was started and preservation of the rootlets and roots was achieved. The matrix of the tumor was originating from the right dentate ligament, which was coagulated and bisected. Total resection of the tumor was achieved and dural defect and the most involved part was stitched to prevent possible CSF leak. Water-tight closure of the dura with routine closure of the wound.

Smooth postoperative recovery. The neurologic deficit still the same.

The patient is complete paraplegia for more than 7 months with scissoring and spastic rigidity of the lower limbs. These data suggest poor postoperative recovery. The patient is young and she is not systematically impaired with diseases such as diabetes mellitus, which could raised the hope for certain recovery. Time will tell the result.

The patient could be sent for urodynamic studies for bladder function evaluation, but the bladder during examination was full, denoting overflow incontinence, but for ethical and time factors and the idea that it will not change the strategy of the operation, this part was ignored.