Medical advancements in neurosurgery have introduced precise techniques for managing rare spinal cord pathologies. A recent case study details a breakthrough in Intramedullary CCM resection, utilizing sodium fluorescein to enhance surgical visualization. This specific tumor, an intramedullary clear cell meningioma (CCM), is exceptionally rare. Specifically, the medical literature contains only two other similar cases globally. Consequently, this report marks the first instance where surgeons employed fluorescence-guided techniques to manage this rare diagnosis.

Innovations in Intramedullary CCM Resection

A 68-year-old male presented with symptoms concerning for thoracic myelopathy, including gait instability and loss of proprioception. Preoperative MRI revealed an intradural, intramedullary contrast-enhancing mass. While the initial differential diagnosis favored ependymoma or astrocytoma, the progressive neurological decline necessitated surgical intervention. Therefore, surgeons performed an Intramedullary CCM resection aided by sodium fluorescein. This fluorescent dye accumulates where the blood-brain barrier is disrupted. Consequently, the dye provides real-time visual guidance, allowing the surgical team to distinguish pathological tissue from healthy spinal cord parenchyma under a yellow 560 filter.

Genetic Markers and Clinical Lessons

Postoperative pathological analysis proved vital for the final diagnosis. The tumor exhibited polygonal cells with clear cytoplasm, which is characteristic of the clear cell variant. Furthermore, genetic testing identified a pathogenic SMARCE1 frameshift mutation. Research indicates that SMARCE1 mutations are strongly linked to clear cell meningiomas, often predisposing patients to spinal locations. Moreover, the successful use of sodium fluorescein in this case suggests its broader utility. This tool effectively identifies tumor margins even in rare intramedullary locations where standard neuronavigation might be limited. Thus, surgeons achieved tumor cytoreduction while obtaining the necessary tissue for molecular diagnosis.

FAQ

What makes an intramedullary clear cell meningioma rare?

Most clear cell meningiomas are intradural-extramedullary. An intramedullary location, where the tumor grows within the spinal cord tissue itself, is exceptionally rare and presents significant surgical challenges.

How does sodium fluorescein assist in spinal surgery?

Sodium fluorescein acts as a visual marker by leaking into tumor tissue through a damaged blood-brain barrier. Under a specific yellow light filter, it allows surgeons to visualize the tumor-cord interface more clearly during the resection process.

What is the clinical significance of the SMARCE1 mutation?

The SMARCE1 mutation is a known driver for clear cell meningiomas. Identifying this mutation helps confirm the histological diagnosis and can guide long-term monitoring, as these tumors often exhibit more aggressive behavior than typical meningiomas.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice. Always seek the advice of a qualified healthcare provider regarding any medical condition or treatment. Refer to the latest local and national guidelines for clinical practice.

References

Bajouri Z et al. Sodium fluorescein-guided resection of an intramedullary spinal cord clear cell meningioma: illustrative case. J Neurosurg Case Lessons. 2026 Apr 27. doi: undefined. PMID: 42044536.

Smith MJ, et al. Germline SMARCE1 mutations predispose to both spinal and cranial clear cell meningiomas. J Pathol. 2014;234(4):436-440.

Olguner SK, et al. Sodium Fluorescein for Spinal Intradural Tumors. Turk Neurosurg. 2021;31(4):534-541.