Symptomatic spinal cord bending after meningioma resection: a technical case report

Resection of intradural tumors is often followed by bending of the spinal cord within the surgical cave. This event is known to be innocuous. We report a case where the position assumed by the spinal cord at the end of surgery was associated with significant MEP decline. The patient, a 44-year-old woman with a meningioma of the cranio-cervical junction, underwent tumor resection aided by intraoperative neurophysiological monitoring. At the time of dural closure, the motor evoked potentials were completely lost on the left side and reduced on the right side . Intraoperative maneuvers showed that worsening was related to the spinal cord position. MEPs were restored by tethering the cord posteriorly, back to its original site. This report underlines the usefulness of maintaining intraoperative monitoring until the end of surgery and provides a technical nuance to manage a rare complication.