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Spinal Meningiomas

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So we say that nerve sheath tumors are the most common

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of the intradural extramedullary neoplasms.

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Number two would be meningioma.

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Meningiomas tend to prefer the thoracic region

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over the cervical and lumbar region.

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And in the thoracic region, they would be the most common

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of the intradural extramedullary neoplasms.

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Occasionally, you will have a meningioma which extends

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beyond the dural surface and grows into, for example,

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the neural foramen or the paraspinal soft tissues.

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So rarely, you will have combined intradural

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as well as extradural meningiomas.

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The demographics of meningiomas are the same

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demographics of meningiomas intracranially, and that is

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that it is more common in women and it peaks

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at about the age forties to fifties.

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Typical features of meningiomas,

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they are typically isointense to the spinal cord on

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both T1-weighted, as well as T2-weighted scans.

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And then they have the broad attachment to the dura

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which may lead to what is referred to

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as the dural tail of enhancement.

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So if we draw the dura here in a sagittal scan,

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so this is anterior and this is posterior,

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what we see with meningiomas is the

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intradural extramedullary mass.

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We'll draw the spinal cord being displaced

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here, with the so-called meniscus sign.

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But as opposed to the neurofibromas or schwannomas,

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one might expect to see a little bit of an enhancing

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dural tail associated with a meningioma.

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So all this is going to enhance and then you'll have

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these trailing off little tails of the dural

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enhancement, the so called dural tail,

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which is characteristic of a meningioma.

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As opposed to neurofibromas or schwannomas,

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meningiomas have the highest rate of calcification of

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intradural extramedullary lesions and they may also lead

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to bone reaction, be it hyperostosis or lysis.

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This is to be distinguished from nerve sheath tumors,

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which generally enlarge foramina or remodel

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it without a lytic or hyperostotic border.

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This is a CT scan of the cervical spine and we

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see a lesion which has hyperdense components.

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So just as intracranially on a non-contrast scan, where

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the most common hyperdense extra axial mass is going to

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be a meningioma. Here we have one in the cervical spine

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where we have a hyperdense mass which has a focus of

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calcification with it, and the spinal cord

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is being displaced to the right side.

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So this would be a characteristic

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feature of a meningioma.

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Little bit surprised that this is also going into

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the neural foramen.

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So this is one that is going both from an intradural

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location to an extradural location, a meningioma.

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Here we have post-gadolinium-enhanced images of the

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cervical spine in the sagittal and axial plane.

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You'll notice that there is a mass which is displacing the

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spinal cord posteriorly and is showing contrast

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enhancement. It has the Dave Yousem meniscus sign,

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that is the widening of the CSF

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above and below the lesion,

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identifying it as an intradural extramedullary lesion.

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Here we have the typical feature of a

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meningioma and that is a dural tail.

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So you see, although we have the central mass here,

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we have these little trailing areas of contrast

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enhancement which identify this as most likely being

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a meningioma rising from the dura as opposed

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to a schwannoma. On the axial scans,

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we again see a little bit of a trailing area of contrast

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enhancement of the meningioma in the right

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intradural extramedullary space.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Spine

Neuroradiology

Neoplastic

Musculoskeletal (MSK)

MRI

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