Data for this review were identified by searches of MEDLINE, PubMed, and references from relevant articles using the following search terms: “spinal”, “intradural”, “intramedullary”, “extramedullary”, “schwannoma”, “neurofibroma”, “myxopapillary ependymoma” “epidermoid”, “dermoid”, “hemangiopericytoma”, “lipoma”, “meningioma”, “paraganglioma”, “metastasis”, “astrocytoma”, “ependymoma”, “ganglioglioma”, “hemangioblastoma”, “lipoma”, “neuroblastoma”, “neurofibroma”, “oligodendroglioma”,
ReviewPart I: Spinal-cord neoplasms—intradural neoplasms
Introduction
Spinal-cord neoplasms (SCNs; figure 1) are an uncommon cause of back pain, radicular pain, and sensorimotor deficits in both adult and paediatric patients. SCNs can be divided into extradural and intradural tumours on the basis of their relation to the thecal sac that surrounds the spinal cord and cauda equina. Extradural tumours, located outside the thecal sac, account for almost 60% of SCNs. About 30% of tumours are contained within the thecal sac and are, therefore, intradural neoplasms. Concomitant intradural and extradural components are associated with roughly 10% of SCNs. Within the intradural compartment, tumours can originate adjacent to (extramedullary) or within (intramedullary) the spinal-cord parenchyma. In view of the heterogeneous cell composition within the intradural compartment, the histogenesis of neoplasms located at this site is varied (panel). Differentiation and diagnosis of intramedullary spinal-cord tumours (IMSCTs) and extramedullary spinal-cord tumours (EMSCTs) are widely achievable through clinical examination and radiographic techniques. MRI is the preferred method of radiographic assessment of intradural spinal tumours and can suggest histological subtype. Other radiographic examinations, such as CT and myelogram, are useful if MRI is contraindicated. Magnetic resonance angiogram (MRA) or spinal arteriogram can be beneficial if the tumour has a vascular component. Histological examination of the tumour after biopsy or surgical resection is able to establish the histogenesis of intradural tumours in almost all cases.
Section snippets
Extramedullary tumours
EMSCTs account for more than 70% of intradural spinal-cord tumours in adults and are only slightly less common in children. The most common primary EMSCTs are derived from sheath cells covering the spinal-nerve roots (schwannomas and neurofibromas) or meningial cells located along the spinal-cord surface (meningiomas). Myxopapillary ependymomas are extramedullary tumours arising from the conus medullaris and filum terminalis. Other tumour types, such as hemangiopericytomas, lipomas,
Intramedullary tumours
IMSCTs account for 20–30% of intradural tumours in adults, and up to 50% of intradural tumours in children.27, 28 Glial tumours, such as astrocytomas and ependymomas, represent up to 80% of IMSCTs, with a paediatric predominance of astrocytomas and an adult predominance of ependymomas. Oligodendrogliomas, mixed gliomas, neuron-derived tumours, gangliogliomas, hemangioblastomas, lipomas, and developmental tumours are uncommon. Finally, metastatic intramedullary spinal-cord tumours account for
Conclusion
Although uncommon, intradural spinal-cord tumours should be an important consideration in the differential diagnosis of the adult or paediatric patient presenting with back or radicular pain associated with neurological deficits. The heterogeneous cell composition within the intradural compartment allows the presence of a histologically variable group of neoplasms. Radiographic assessment combined with histological examination helps with the identification of the histogenesis of these tumours,
Search strategy and selection criteria
References (76)
- et al.
Spinal neurinomas: retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature
Surg Neurol
(2004) - et al.
Spinal tumors
Eur J Radiol
(2004) - et al.
Paraganglioma of the cauda equina: a case report and literature review
Surgeon
(2005) - et al.
Prognostic factors in intramedullary astrocytomas
Clin Neurol Neurosurg
(1997) - et al.
Pediatric spinal cord tumor surgery
Neurosurg Clin N Am
(1990) - et al.
Postoperative radiotherapy of spinal and intracranial ependymomas: analysis of prognostic factors
Radiother Oncol
(1997) - et al.
Spinal cord ganglioglioma in childhood
Pathol Res Pract
(1993) - et al.
Intramedullary spinal cystic teratoma of the conus medullaris with caudal exophytic development: case report
Surg Neurol
(1994) - et al.
Spinal intradural tumours: Part I--Extramedullary
Br J Neurosurg
(1999) - et al.
Clinical characteristics of spinal nerve sheath tumors: analysis of 149 cases
Neurosurgery
(2005)
Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management
Surg Neurol
Review of 36 cases of spinal cord meningioma
Spine
Clear cell meningioma: case report and review of the literature
Pediatr Dev Pathol
Spinal meningiomas: review of 174 operated cases
Neurosurgery
Intraspinal hemangiopericytomas. Report of two cases and review of the literature
Spine
Meningeal hemangiopericytoma: a retrospective study of 21 patients with special review of postoperative external radiotherapy
Neurosurgery
Intradural hemangiopericytoma of the lumbar spine: case report
Neurosurgery
Tethered cord syndrome in adults
Surg Neurol
Congenital lumbosacral lipomas
Childs Nerv Syst
Ependymoma of the filum terminale: treatment and prognostic factors in a series of 28 cases
Acta Neurochir (Wien)
Ependymoma of the cauda equina region: diagnosis, treatment, and outcome in 15 patients
Neurosurgery
Ependymomas of the filum terminale in childhood: report of four cases and review of the literature
Childs Nerv Syst
Paragangliomas of the spinal canal
Neuroradiology
Intradural paraganglioma of the thoracic spine
AJNR Am J Neuroradiol
MR findings of the spinal paraganglioma: report of three cases
J Korean Med Sci
Nonfunctioning malignant paraganglioma of the posterior mediastinum with spinal cord compression. A case report
Spine
Intraspinal epidermoid and dermoid cysts. Surgical results of seven cases
Arch Orthop Trauma Surg
Long-term results of the surgical treatment of spinal dermoid and epidermoid tumors
Neurosurgery
The surgical treatment of metastatic spinal tumors within the intradural extramedullary compartment
J Neurosurg
Neoplastic meningitis
J Clin Oncol
Intramedullary spinal cord tumors in children under the age of 3 years
J Neurosurg
Intramedullary neoplasms and vascular malformations
Clin Neurosurg
Non-neoplastic intramedullary pathology. Diagnostic dilemma: to Bx or not to Bx
J Neurooncol
Nonneoplastic intramedullary spinal cord lesions mimicking tumors
Neurosurgery
Intramedullary ependymomas: clinical presentation, surgical treatment strategies and prognosis
J Neurooncol
Spinal intradural tumours: Part II-intramedullary
Br J Neurosurg
Clinical and pathological analysis of spinal cord astrocytomas in children
Neurosurgery
Cited by (110)
Intradural extra medullary spinal tumours – An urban institute's experience
2023, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementThoracic schwannoma presenting with chronic abdominal pain: A case report
2023, Asian Journal of SurgeryRisk factors for recurrence and regrowth of spinal schwannoma
2023, Journal of Orthopaedic ScienceThe effect of intraoperative neurophysiological monitoring on neurological outcomes after spinal tumors operations: A single institution experience
2023, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :Total resection is the “gold standard” in mostly intraspinal tumors. On the contrary, whenever that tumors are adjacent to important structural, total resection is not safe [4–5]. In spinal surgery, the removal of a lesion within the spinal cord always carries a risk of postoperative neurological damage. [6]
Neuroimaging for surgical treatment planning of neoplastic disease of the spine
2022, Handbook of Neuro-Oncology Neuroimaging