Interactive Transcript
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This was a woman who was operated previously for
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cervical spine pain and was being followed up for
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persistent pain. On the sagittal T1-weighted scan,
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we see the post-operative changes here at C2,
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C5, and C6, with anterior plate and screws
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for the fusion at C5 and C6.
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We see a little bit of an indentation by the
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disc at the C5-C6 level on the thecal sac.
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And you'll notice that the thecal sac is narrowed here because
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this is an extradural impression on the thecal sac.
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So narrowing as opposed to widening.
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When we scroll the patient scans,
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we notice that there is a mass which
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is seen here at the C2 level,
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which has a different characteristic
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feature from the disc,
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and that is that there's widening of this cerebrospinal
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fluid at the border with the lesion.
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And therefore this is an intradural extramedullary
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mass. It is displacing the spinal cord posteriorly.
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As we scroll,
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we see that the spinal cord is being displaced slightly
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and there is a tiny area of high signal intensity within
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the spinal cord anteriorly from that compression.
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Let's look on the axial scans now.
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So scrolling through these images,
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we see that the lesion is to the left of midline,
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that it is closely associated with the neural foramen,
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but is within the thecal sac.
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And there is that indentation on the spinal cord,
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causing it to have this kind of semilunar appearance in
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a tiny area where there is bright signal intensity
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in the anterior portion of the spinal cord,
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although not dramatic.
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Post-gadolinium enhance scans were also performed
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in the sagittal and axial plane.
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Here we see that the lesion shows contrast enhancement
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quite avidly, and is associated with the anterior dura.
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I'm going to demonstrate that there is a small, little
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area of enhancement of the dura leading superior
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from the lesion, the so called dural tail.
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And on the axial scan,
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we see that this has that basis along the anterior
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border of the dura to the left of midline.
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I'm going to maximally magnify this,
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so that way that dural tail is going to be better seen.
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And I'll point that out once again, that this small
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trailing area of enhancement is what is referred
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to as the dural tail of a meningioma.
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So even though this lesion is located
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in the cervical region,
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and you've heard me say numerous times that nerve sheath
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tumors are much more common than meningiomas
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in the cervical region.
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And even though this is a patient who
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has a lesion anteriorly located.
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Whereas, more commonly, meningiomas are posteriorly
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located in the thecal sac. By virtue of
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that enhancing dural tail,
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I would describe this lesion as a
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C2 intradural extramedullary mass
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with features of a dural tail,
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making meningioma more likely than schwannoma.
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Really, there are no other tumors that we would suggest besides
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the nerve sheath tumors and the meningioma in this case.
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