Clin Orthop Surg.  2009 Jun;1(2):74-80. 10.4055/cios.2009.1.2.74.

Surgical Results of Intradural Extramedullary Tumors

• Song KW
• Shin SI
• Lee JY
• Kim GL
• Hyun YS
• Park DY

• KMID: 1122636
• DOI: http://doi.org/10.4055/cios.2009.1.2.74

Abstract

BACKGROUND: To report the treatment results of 12 patients who underwent a total excision of intradural extramedullary tumors.
METHODS
Twelve cases of histopathologically confirmed intradural extramedullary tumors were treated surgically between February 2002 and March 2005. There were 8 males and 4 females with an average age of 42.6 years. The mean postoperative follow-up period was 24.2 months. The histopathological findings, locations of the tumors, and clinical results were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel classification.
RESULTS
The histopathological results are as follows: 4 cases of a meningioma, 4 cases of a schwannoma, 2 cases of an epidermoid cyst, 1 case of an arachnoid cyst, and 1 case of an ependymoma. The locations of the tumors were as follows: 7 cases in the thoracic region, 4 cases in the lumbar region, and 1 case in the cervical region. At the final follow-up, a 2-grade and 1-grade improvement was observed in 1 and 7 cases, respectively. There were no changes in the Frankel grade in 4 cases. The preoperative neurological deficit improved within 8 postoperative weeks in most cases and within 1 postoperative year in all cases. Postoperatively, there were 2 cases of cerebrospinal fluid leakage and 2 cases of paresthesia.
CONCLUSIONS
Intradural extramedullary tumors detected by MRI are mostly benign and good clinical results can be obtained when treated surgically. Therefore, more active surgical approaches by orthopedic surgeons are recommended to decrease morbidity.

Keyword

Intradural; Extramedullary; Tumor

MeSH Terms

Adult
Aged
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Orthopedic Procedures/methods
Spinal Cord Neoplasms/diagnosis/pathology/*surgery
Young Adult

Figure

• 

  Fig. 1 Forty-seven-year-old female with intradural extramedullary menigioma with paraparesis. (A) T1-weighted sagittal MR image shows homogenous high signal intensity mass. The tumor is located at the T10-11 level. (B) T1-weighted coronal MR image shows a space occupying mass compressing the spinal cord. (C) Histopathology findings shows a whorl pattern of cellular growth characteristics of a meningioma (original magnification, × 300).

• 

  Fig. 2 Seventy-four-year-old female with intradural extramedullary schwannoma with back pain and a sensory decrease. (A) T1-weighted sagittal MR image shows two homogenous iso-signal intensity masses. The tumor is located at the L2-3, 4-5 level with dumbbell shape for-mation. (B) Gadolinium enhanced T1-weighted sagittal MR image shows marginal enhancement of heterogeneous high signal intensity mass. (C) Gadolinium enhanced T1-weighted axial MR image shows space occupying intradural extramedullary mass compressing spinal cord to the left side. (D, E) Intra-operative findings of intradural extramedullary mass excision. (F) Extracted tumor showing a well encapsulated masses measuring 3.5 × 1.5 × 1 cm and 1.5 × 1 × 1 cm connected with linear stock.

• 

  Fig. 3 Thirty-five-year-old male with intradural extramedullary schwannoma with both upper & lower extremity weakness and tingling sensation below C3 level. (A) T2-weighted sagittal MR image shows a huge homogenous high signal intensity mass. The tumor is located at the C1-2 level. (B) T2-weighted coronal MR image shows a space occupying mass compressing the spinal cord severely. (C) Intra-operative findings of intradural extramedullary mass excision. (D) Extracted tumor showing a well encapsulated mass measuring 1.6 × 1 × 0.8 cm. (E) Postoperative MR image shows mass lesion removed at the C1-2 level, but the spinal cord signal changes remain.

• 

  Fig. 4 Fifty-seven-year-old male with intradural extramedullary ependymoma with lower leg weakness. (A) T1-weighted sagittal MR image shows heterogeneous high signal intensity mass. The tumor is located at the L2-3 level with longitudinal oval shape formation. (B) T1-weighted coronal MR image shows space occupying mass compressing the spinal cord severely. (C) Extracted tumor showing a well encapsulated capsular shaped mass measuring 4.2 × 1.3 × 1 cm. (D) Histopathology findings shows a circular arrangement of cells around a clear space: perivascular pseudorosette formation characteristics of ependymoma (original magnification, × 60).

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