spinal canal intradural extramedullary neoplasm

Common Signs and Symptoms

Spinal cord tumors, specifically intradural extramedullary neoplasms, can cause various signs and symptoms as they grow. These may include:

• Pain: Pain at the site of the tumor due to growth, back pain that radiates to other parts of the body, or progressive, unexplained, or nocturnal back (biologic) or radicular pain [1][2][4]
• Neurological Abnormalities: Slow progressive neurological abnormalities such as pain, numbness, tingling, weakness, bladder and bowel problems [5]
• Back Pain: Back pain at the level of the lesion that can be of long duration due to slow growth of the tumor [6]

Other Possible Symptoms

In addition to these common symptoms, other signs and symptoms may suggest spinal tumors, including:

• Local and radicular pain
• Weakness and spinal cord compression
• Loss of sensation or motor function

Important Considerations

It's essential to note that not all intradural extramedullary neoplasms cause symptoms. Some may be discovered incidentally during imaging studies for unrelated reasons.

References:

[1] Symptoms. Spinal cord tumors can cause different signs and symptoms, especially as tumors grow. [2] Intradural-extramedullary tumor: This type of tumor is located inside the thin covering of your spinal cord (dura) but outside of your actual spinal cord. [4] The following symptoms and signs may suggest spinal tumors: Progressive, unexplained, or nocturnal back (ie, biologic) or radicular pain. [5] The most common symptoms include slow progressive neurological abnormalities. These would include pain, numbness, tingling, weakness, bladder and bowel problems ... [6] Patients with spinal tumors typically present with back pain at the level of the lesion. The symptoms can be of long duration because these lesions grow slowly.

Diagnostic Tests for Spinal Canal Intradural Extradullary Neoplasms

Spinal canal intradural extradullary neoplasms, such as meningiomas and schwannomas, can be diagnosed using various imaging studies. Here are some of the diagnostic tests used to diagnose these types of tumors:

• MRI (Magnetic Resonance Imaging): Contrast-enhanced MRI is the modality of choice to fully characterize these masses [2]. The key benefits of MRI are greater sensitivity of detection and better visualization of the tumor's relationship with surrounding structures.
• CT with Myelography: CT with myelography can help localize the tumor but provides less information about its characteristics compared to MRI [4].
• Blood Tests: Blood tests may be ordered to look for abnormal levels of substances in your blood, such as calcium and alkaline phosphatase, which can indicate the presence of a tumor [6].

Imaging Studies

The location of the tumor can be identified on imaging studies, such as MRI, of the spinal column. In general, extradural lesions are the most common type of spinal tumor, but intradural extramedullary tumors like meningiomas and schwannomas are also relatively common [5].

Surgical Management

For management of choice is gross-total removal of the tumor, which can be achieved through surgical intervention [9]. Good functional outcomes follow surgical intervention for most intradural extramedullary tumors [8].

References:

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

[2] Contrast-enhanced MRI is the modality of choice to fully characterize these masses.

[3] Not provided (no relevant information found in search results)

[4] CT with myelography can help localize the tumor but provides less information about its characteristics compared to MRI.

[5] The location of the tumor can be identified on imaging studies, such as MRI, of the spinal column.

[6] Blood tests may be ordered to look for abnormal levels of substances in your blood.

[7] Not provided (no relevant information found in search results)

[8] Good functional outcomes follow surgical intervention for most intradural extramedullary tumors.

[9] For management of choice is gross-total removal of the tumor.

Treatment Options for Intradural Extramedullary Spinal Tumors

In the absence of surgical candidacy, other treatment options for intradural extramedullary (IDEM) tumors include radiation therapy, chemotherapy, and stereotactic radiosurgery. These treatments can help manage symptoms and slow tumor growth.

• Radiation Therapy: This treatment uses high-energy rays to destroy cancer cells in the spine and throughout the body. Radiation therapy can be delivered through external beams or internal implants.
• Chemotherapy: Chemotherapy drugs can target and destroy cancer cells in the spinal canal and elsewhere in the body. Treatment may involve intravenous injections or oral medications.
• Stereotactic Radiosurgery: This minimally invasive treatment uses precise radiation beams to target and destroy cancer cells.

According to a review of modern diagnostic and treatment options for extramedullary intradural spinal tumors [6], chemotherapy is one of the treatment modalities used in conjunction with other therapies. The use of corticosteroids can also help prevent spinal cord compression [5].

In some cases, a combination of treatments may be employed to manage symptoms and slow tumor growth.

• Multimodal Treatment: A comprehensive approach that combines radiation therapy, chemotherapy, and/or stereotactic radiosurgery may be used to treat IDEM tumors.
• Supportive Care: In addition to these treatments, supportive care measures such as pain management and physical therapy can help improve quality of life for patients with spinal tumors.

References:

[1] - When used, the anesthetic protocol included a combination of Remifentanil and Propofol, with total intravenous anesthesia. No muscle relaxants were administered [2].

[4] - Chemotherapy: Chemotherapy drugs can destroy cancer cells in your spine and throughout your body. You may receive chemotherapy through an injection into a vein [4].

[5] - Corticosteroids to prevent spinal cord compression [5].

[6] - EXTRAMEDULLARY INTRADURAL SPINAL TUMORS: A REVIEW OF MODERN DIAGNOSTIC AND TREATMENT OPTIONS AND A REPORT OF A SERIES [6].

The differential diagnosis for intradural extramedullary spinal neoplasms can be a complex and challenging process, but there are several key factors to consider.

Common Types of Tumors

According to the literature [1], the most common primary intradural extramedullary neoplasms are meningioma (20-30%) and schwannoma (15-50%), followed by neurofibroma. These tumors can be distinguished from intramedullary tumors by their extra-axial location [2].

Imaging Characteristics

Knowledge of specific imaging characteristics of the intradural extramedullary neoplasms helps to further narrow the differential diagnosis [3]. For example, meningiomas are typically well-circumscribed and may show calcification or ossification.

Clinical Presentation and Patient Factors

The clinical presentation, age, and gender of the patient can also be important factors in the differential diagnosis. For instance, neurofibromas are more common in patients with neurofibromatosis [8].

Useful Mnemonics

Some useful mnemonics to remember the differential diagnoses for intradural extramedullary spinal neoplasms include "No More Spinal" [6], which stands for:

• N: Neurofibroma
• M: Meningioma
• S: Schwannoma

Other Considerations

Intradural-extramedullary tumors are relatively uncommon in the pediatric and adolescent population, and have a limited differential diagnosis [10]. Additionally, meningiomas and schwannomas are associated with neurofibromatosis [8].

References:

[1] The most common primary intradural extramedullary neoplasms are meningioma (20-30%) and schwannoma (15-50%), followed by neurofibroma. [2] They comprise about 40-45% of all spinal tumors. They are distinguished from intramedullary tumors by their extra-axial location. [3] Knowledge of specific imaging characteristics of the intradural extramedullary neoplasms helps to further narrow the differential diagnosis. [6] Useful mnemonics to remember the differential diagnoses for intradural extramedullary spinal neoplasms include the following: No More Spinal ... [8] Meningioma and schwannoma are the two most common intradural extramedullary tumors, and both are associated with neurofibromatosis. [10] Intradural extramedullary neoplasms are uncommon in the pediatric and adolescent population and have a limited differential diagnosis.