Interactive Transcript
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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.
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