Trap-door durotomy for ventral calcified thoracic meningioma

Ventral calcified meningiomas of the upper thoracic spine provide a unique challenge due to their location. The posterior approach has long been utilized for resection of ventral meningiomas with high success rates and low morbidity. There are a number of anatomical factors that can increase the difficulty in the case including patient body habitus, calcified tumors ventrally located can be adherent to the cord or anterior spinal artery, angle of the ribs and the vascularity in and around the tumor. We present a very challenging case of a large ventral calcified meningioma at T4 in a patient with body mass index of 50 (5′6, 337 lbs) who presented with progressive paraplegia.