J Korean Soc Spine Surg.  2002 Sep;9(3):230-237. 10.4184/jkss.2002.9.3.230.

Surgical Treatments of Intradural Extramedullary Tumor

• Shin BJ
• Lee JC
• Yoon TK
• Jung HW
• Han SW
• Kim DW
• Kim KJ
• Kim YI

• KMID: 2003230
• DOI: http://doi.org/10.4184/jkss.2002.9.3.230

Abstract

STUDY DESIGN: Retrospective study on 12 cases of intradural extramedullary tumor. OBJECTIES : To analyze the clinical symptoms and the outcome of the treatments in the 12 patients who had intradural extramedullary tumors. SUMMARY OF LITERATURE REVIEW : In order to provide a good prognosis and achieve a satisfactory clinical outcome for the treatment of intradural extramedullary tumors, early diagnosis and careful surgical resection is necessary.
MATERIALS AND METHODS
Twelve cases of intradural extradmedullary tumors were treated surgically from September 1990 to July 2000. Of the 12 cases, 7 were male and 5 were femal. Average follow-up period was 37 months. Mean age of the cases was 48.3 years. The followings were analyzed; 1)histopathologic diagnoses, 2)locations of tumors, 3)clinical findings, 4)duration of symptoms, and 5)radiologic findings. In addition, both changes of symptoms as well as neurologic findings during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel's and Kim 's criteria.
RESULTS
Histiopathologic results were as follows; 6 cases (50%) confirmed as schwannoma, 3 cases (25%) as meningioma, 1 case as epidermoid cyst, 1 case as neurofibroma, and 1 case as arachnoid cyst. Locations of tumors were as follows; 6 cases (50%) located in the thoracic region, 4 cases (33%) located in the lumbar, 1 case located in the cervical region, and 1 case located in the sacrum. Clinical findings were as follows: 6 cases complained of back pain and radiating pain to leg, 6 cases noticed motor weaknesses and sensory changes of varying degrees. The average duration from initial symptoms to admission was 57 months (23-140 months). Laminectomy and complete resection of tumors were performed in all cases. Posterior spinal fusion with instrumentation was necessary only in one case. The preoperative Frankel's grades were as follows; 6 cases were in grade C, 4 cases in grade D, and 2 cases in grade E. At the final follow-up, all cases were graded as E .
CONCLUSION
The Early diagnosis and careful surgical resection for intradural extramedullary tumors provide for a good prognosis as well as a positive clinical outcome. Intradural tumors should be included in the differential diagnosis of spine diseases and considered as a subdivision of orthopaedic spine surgery.

Keyword

Intradural; Extramedullary; Tumor

MeSH Terms

Arachnoid
Back Pain
Diagnosis
Diagnosis, Differential
Early Diagnosis
Epidermal Cyst
Follow-Up Studies
Humans
Laminectomy
Leg
Male
Meningioma
Neurilemmoma
Neurofibroma
Neurologic Manifestations
Prognosis
Retrospective Studies
Sacrum
Spinal Fusion
Spine

Figure

• 

  Fig. 1-A. T1-weighted sagittal MR image shows peripheral iso-signal intensity and central low signal intensity mass. The tumor is located at the C4-5 level with extension of the tumor forming a dumbbell shaped mass. Fig. 1-B. Gadolinium enhanced T1-weighted sagittal MR image shows marginal enhancement of homogenous high signal intensity mass. Fig. 1-C. Gadolinium enhanced T1-weighted axial MR image shows a dumbbell shape intradural extramedullary mass compressing spinal cord to the left side. Fig. 1-D. Cross section of the tumor showing a well encapsulated ovoid mass measuring 1.8× 1.1× 0.5 cm (0.94 g). Fig. 1-E. The tumor is composed of spindle cells with nuclear palisading and shows vascular hyalinization (H-E stain, × 200). These findings are compatible with schwannoma.

• 

  Fig. 2-A. T1-weighted sagittal MR image shows peripheral iso signal intensity and low signal intensity mass. The tumor is located at the T9-10 level. Fig. 2-B. Gadolinium enhanced T1-weighted sagittal MR image shows marked enhanced of peripheral portion of the mass. Fig. 2-C. T2-weighted axial MR image shows a well demarcated homogenous high signal intensity mass. Fig. 2-D. Cross section of the tumor showing a bean shape mass measuring 2× 1× 0.5 cm (1.89g). Fig. 2-E. Microscopic findings of the tumor show syncytial appearance, intranuclear pseudoinclusions, and psam-moma bodies(H-E stain, × 200). Histologic diagnosis is meningioma.

Reference

1). Cheng MK. Spinal cord tumors in the People's Republic of China: a statistical review. Neurosurg. 10:22–24. 1982.

2). Cushing H, Eisenhardt L. Meningiomas: their classification, regional behavior, life history, and surgical end results. Springfield: Charles C Thomas;p. 735. 1938.

3). Connoly ES. Spinal cord tumors in adults. (in: Youmans JR eds. Neurological surgery. 2nd ed.Philadelphia: WB Saunders Co;p. 3196–3214. 1982. .).

4). Dancy WE. The diagnosis and localization of spinal cord tumors. Ann Surg. 81:222–254. 1925.

5). Elsberg CA. Tumors of the spinal cod and symptoms of irritation and compression of the spinal cord and nerve roots. pathology, symptomatology, diagnosis and treatment. New York: Paul B. Hoeverg;p. 206–239. 1925.

6). Greenwood J Jr. Surgical removal of intramedullary tumors. J Neurosurg. 26:276–283. 1967.

7). Harry N. The spine. 4th ed. Philadelphia: WB Saunders Co;1366. 1998.

8). Horsley V, Gowers WR. A case of tumor of the spinal cord. Trans Roy Med Chir Soc Glag. 70:377–378. 1888.

9). Kim SS, Denis F, Lonstein JE, Winter RB. Factors affecting fusion rate in adults spondylolisthesis. Spine. 15:979–984. 1990.

10). Nittner K. Spinal meningiomas, neurinomas, and neu -rofibroma-hourglass tumors. Handbook of Clinical Neurology. 20. Amsterdam: North-Holland Publishing Co;p. 177–322. 1976.

11). Sicard JR, Forester J. Methode radiographigue dex -ploration de la cavite epidurale lipiodol, Rev Neurol. 28:1264. 1921.

12). Simeone FA. Spinal cord tumors in adult. (in: Yomans JR eds. Neurological surgery. 3rd ed.Philadelphia: WB Saunders Co;p. 3531–3547. 1990. .).

13). Steinke CR. Spinal tumors: statistics on a series of 330 collected cases. J Nerv Ment Dis. 47:418–426. 1918.

14). Vinken PJ, Bruyn GW. Handbook of clinical neu -rology. Tumors of the spine and spinal cord. New York: American Elsevier Publishing Co;Part 2,. 20:p. 238–289. 1976.