Intradural spinal tumors (tumors within the spinal fluid sac) can be divided to intramedullary (within spinal cord) or extramedullary (outside of spinal cord) tumors.  Extramedullary spinal tumors are far more common than intramedullary tumors.  The most common extramedullary spinal tumors are meningiomas and schwannomas and they are both benign tumors.  Meningiomas arise from arachnoid cap cells within the leptomeninges (covering tissues) of the spinal cord.  Schwannomas are benign tumors that arise from Schwann cells (supporting cells for peripheral nerves).  The most common intramedullary spinal tumors are ependymomas, astrocytomas, and hemangioblastomas.  These tumors arise from various cells that populate the spinal cord.

Cause:

In general, tumor growth occurs because of aberration of genetic or cellular processes.  Occasionally, genetic diseases and hereditary traits predispose individuals at risk for tumor development.

Symptoms:

Patients with intradural tumor generally present with neurological symptoms, and they include pain, weakness, sensory loss, difficulty with walking, paralysis, or loss of bladder and bowel functions.

Diagnostic tests:

Evaluation of intradural tumors requires MRI imaging of the spine with and without contrast infusion.  Tumors generally have disruption of normal blood vessel barrier and the contrast is extravasated into the tumors to demonstrate contrast-enhancing lesions. MRI provides the most detailed images that can demonstrate the tumor and its relationship to normal spinal cord tissues and pathways.  This relationship between tumor and normal spinal tumor is essential for pre-surgical planning.

Treatment:

Standard treatment of intradural dural spinal tumors is gross total resection when it is safe and possible.  Extramedullary tumors often have distinct tissues planes that allow safe dissection of tumors away from the spinal cord to achieve complete tumor removal.  Some intramedullary tumors, such as ependymomas and hemangioblastomas, also have distinct planes from normal spinal cord tissues that allow for safe complete tumor resection.  On the other hand, astrocytomas are more diffuse and infiltrating.  These tumors often intermingle with normal spinal cord tissue and complete tumor resection is not possible without significant risk of spinal cord injury.  At USC Neurosurgery Spine Centers, intradural spinal tumors are treated by experienced neurosurgeons with the most sophisticated surgical techniques and technology currently available.  All spinal tumor surgeries at USC are performed using the most advanced and real-time neurological monitoring of spinal conduction pathway through the length of the procedures.  Our ultimate goal is to provide patients with the most optimal opportunity for long-term survival, while preserving neurological function and quality of life.

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