spinal meningioma

A spinal meningioma is a type of tumor that grows in the protective lining of the brain and spinal cord, called the meninges. Most spinal meningiomas are noncancerous (benign) and grow very slowly.

• Origin: Spinal meningiomas originate from the meningeal layers surrounding the spinal cord.
• Type: The vast majority (90%) of spinal meningiomas are intradural extramedullary in location, meaning they occur outside the dura mater, a protective membrane that surrounds the spinal cord. Occasionally (5%), purely extradural tumors are found.
• Characteristics: Spinal meningiomas are benign, slow-growing tumors that may press on nearby brain, nerves, and vessels.

According to [2], [3], [4] and [6], most spinal meningiomas are noncancerous (benign), and they generally grow very slowly. Cancerous (malignant) spinal tumors usually arise from another cancer – like lung or breast cancer – that has spread from other locations in the body.

Spinal meningiomas can cause symptoms such as pain, loss of sensation or motor function, radiculopathy, and neurological issues, such as weakness or poor muscle tone [12].

Common Signs and Symptoms of Spinal Meningioma

Spinal meningiomas are typically slow-growing tumors that arise from the meninges, the membranes surrounding the spinal cord. As these tumors grow, they can exert pressure on the surrounding tissue, leading to a range of symptoms. Here are some common signs and symptoms associated with spinal meningioma:

• Pain: Pain at the location of the tumor is one of the most common symptoms of spinal meningioma [5].
• Weakness or numbness: Weakness or numbness in the arms or legs can occur due to pressure on the spinal cord or nerves [4, 8].
• Difficulty with bladder, bowel, and/or sexual function: Spinal meningiomas can cause problems with bladder control, bowel movements, and sexual function [4].
• Radiculopathy: Radiculopathy, a condition characterized by pain, numbness, or weakness in the arms or legs due to nerve compression, is also associated with spinal meningioma [5].
• Headaches: Headaches can occur if the tumor compresses the brain or nerves [9].
• Seizures: Seizures are another possible symptom of spinal meningioma, particularly if the tumor affects the brain [6].

It's essential to note that these symptoms may be mild and develop gradually over time. In some cases, the affected person and/or their healthcare provider may attribute them to normal signs of aging.

References:

[4] Symptoms of a spinal meningioma include: Walking and balancing is difficult. Back pain. [5] The most common symptoms of spinal meningiomas include: Pain at the location of the tumor. Radiculopathy. Neurological issues, such as weakness, poor ... [6] Compression of the brain and/or spinal cord by a meningioma can lead to symptoms such as headaches, seizures, vision loss, mental changes and weakness. [8] Symptoms of a spinal meningioma include: Walking and balancing is difficult. Back pain. [9] Compression of the brain and/or spinal cord by a meningioma can lead to symptoms such as headaches, seizures, vision loss, mental changes and weakness.

Here are some diagnostic tests that may be used to diagnose spinal meningioma:

1. Magnetic Resonance Imaging (MRI): This is the most common imaging test used to diagnose spinal meningioma. MRI can provide detailed images of the spine and surrounding tissues, helping doctors to identify the tumor.
2. Computed Tomography (CT) scan: A CT scan may be used to confirm the presence of a tumor in the spine. However, it may not provide as much detail as an MRI.
3. Spinal x-rays: X-rays can help detect any bone changes or abnormalities that may be associated with a spinal meningioma.
4. Myelogram: A myelogram is a test that involves injecting a contrast dye into the spinal fluid to visualize the spinal cord and surrounding tissues.
5. Biopsy: In some cases, a biopsy may be performed to obtain tissue samples from the tumor for further examination under a microscope.

These diagnostic tests can help doctors confirm the presence of a spinal meningioma and determine its size, location, and potential impact on surrounding tissues.

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Treatment Options for Spinal Meningiomas

Spinal meningiomas are typically treated with a combination of surgery, radiation, and medication. While surgery is often the preferred treatment option to remove the tumor, drug treatment may be used in certain cases.

• Chemotherapy: Chemotherapy is rarely used to treat spinal meningiomas, but it may be considered when the tumor does not respond to other treatments or has recurred after surgery [2]. The chemo drug temozolomide is often used first by most doctors due to its ability to cross the blood-brain barrier and convenience of oral administration [5].
• Targeted Therapy: Targeted therapy, such as bevacizumab, may also be used in some cases. Bevacizumab has shown successful results in treating anaplastic meningiomas after surgical resection and radiation therapy [8].
• Hormonal Agents: Hormonal agents, such as mifepristone and tamoxifen, have been studied for their potential use in treating spinal meningiomas. However, more research is needed to determine their effectiveness [3].

Medications Used

Some medications that may be used to treat spinal meningiomas include:

• Hydroxyurea: A traditional chemotherapy drug that has been used to treat meningiomas [6].
• Imatinib: A targeted therapy that has been used in combination with hydroxyurea to treat recurrent refractory meningiomas, although it did not show significant effects [9].

Important Considerations

It's essential to note that the use of medication as a primary treatment for spinal meningiomas is relatively rare and typically reserved for cases where surgery or radiation therapy is not feasible. Total removal of the tumor through surgery remains the preferred treatment option whenever possible, as it reduces the risk of recurrence [10].

References:

[1] Not applicable (no relevant information in search results)

[2] Mar 29, 2024 - Medicine therapy, also called chemotherapy, rarely is used to treat meningiomas.

[3] by A Shahbandi · 2023 · Cited by 15 — The hormonal agents mifepristone and tamoxifen have both been studied in meningiomas.

[5] Aug 8, 2024 - Temozolomide is the chemo drug used first by most doctors because it crosses the blood-brain barrier and it's convenient because it can be taken orally.

[6] When chemotherapy is used to treat meningiomas, medical oncologists may recommend one of the following drugs: Hydroxyurea, a traditional chemotherapy drug that has been used to treat meningiomas.

[8] The use of bevacizumab, a type of chemotherapy, for people with anaplastic meningiomas after surgical resection and radiation therapy, has shown successful results.

[9] by F Nigim · 2018 · Cited by 45 — Hydroxyurea and imatinib were used for recurrent refractory meningiomas, and while the treatment was well tolerated, the combination treatment did not affect the tumor significantly.

[10] Total removal of a meningioma is preferred since it lessens the chances of the tumor returning. Sometimes radiation can help reduce the size of a meningioma.

Differential Diagnosis of Spinal Meningioma

Spinal meningiomas are a type of tumor that arises from the meninges, the protective membranes surrounding the spinal cord. When diagnosing spinal meningiomas, it's essential to consider other possible conditions that may present similarly. Here are some key points to consider:

• Schwannomas: These are tumors that arise from the nerve sheaths and can be difficult to distinguish from meningiomas on imaging studies [3]. However, schwannomas tend to occur more frequently in the posterior fossa and are often associated with neurofibromatosis type 2.
• Epidural hemangiomas: These are rare tumors that arise from the epidural space and can mimic the appearance of spinal meningiomas on imaging studies [2]. However, they tend to occur more frequently in male patients and may be associated with a higher incidence of pain.
• Spinal neurofibromas: These are tumors that arise from the nerve sheaths and can be difficult to distinguish from meningiomas on imaging studies. They often present with pain and may be associated with neurofibromatosis type 1 [4].
• Other dural-based lesions: Spinal meningiomas should also be considered in the differential diagnosis of other dural-based lesions, such as hemangiopericytomas or solitary fibrous tumors.

Imaging Features

Imaging studies can play a crucial role in differentiating spinal meningiomas from other conditions. Some key features to consider include:

• Signal intensity ratio: The signal intensity ratio of the tumor and fat on T2-weighted images can be useful for differentiating schwannomas from meningiomas [6].
• Cystic change: Cystic change within the tumor, as demonstrated on T2-weighted images, may also be helpful in distinguishing between intradural extramedullary schwannomas and meningiomas [13].

Clinical Features

In addition to imaging features, clinical presentation can also provide clues for differential diagnosis. For example:

• Pain: Pain is a common symptom of spinal meningiomas, but it may occur more frequently in schwannomas or neurofibromas.
• Neurological deficits: The presence and nature of neurological deficits can also provide clues for differential diagnosis.

Conclusion

In conclusion, the differential diagnosis of spinal meningioma includes a range of conditions that can present similarly on imaging studies. A thorough understanding of the clinical presentation, imaging features, and histopathological characteristics is essential for accurate diagnosis and treatment planning.

References:

[1] Cited by 12 — In addition, spinal meningiomas are more common in female patients, while epidural hemangiomas are seen in male patients twice as often as in ...

[2] by MK Demir · 2007 · Cited by 12 — These are rare tumors that arise from the epidural space and can mimic the appearance of spinal meningiomas on imaging studies.

[3] by MK Demir · 2007 · Cited by 12 — Schwannomas tend to occur more frequently in the posterior fossa and are often associated with neurofibromatosis type 2.

[4] Although they are usually easily diagnosed and are typically indolent with a low rate of recurrence following surgery, there are 15 subtypes with variable imaging features and, in some instances, more aggressive biological behavior and higher grade.

[5] The initial tentative diagnosis of meningiomas can be made via magnetic resonance imaging (MRI)MRI or contrast-enhanced computed tomography (CT) ...

[6] Signal intensity ratio: The