Journal List > J Korean Soc Spine Surg > v.9(3) > 1036022

TOOLS
Shin, Lee, Yoon, Jung, Han, Kim, Kim, and Kim: Surgical Treatments of Intradural Extramedullary Tumor
Original Article

Journal of Korean Spine Surg 2002;9(3):230-237.

Published online: 21 February 2002

DOI: https://doi.org/10.4184/jkss.2002.9.3.230

Surgical Treatments of Intradural Extramedullary Tumor

Byung-Joon Shin, M.D., Jae-Chul Lee, M.D., Tae-Kyung Yoon, M.D., Ho-Won Jung, M.D., Sung-Woo Han, M.D., Dong-Won Kim, M.D.∗, Kyung-Je Kim, M.D., Yon-Il Kim, M.D.

Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea

∗Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea

Address reprint requests to Byung-Joon Shin, M.D. Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Joongdong 1174, Bucheonsi, Gyeonggido, Korea Tel : 82-32-621-5259, Fax : 82-32-324-9577, E-mail : schsbj@schbc.ac.kr

Copyright © 2002 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study on 12 cases of intradural extramedullary tumor

Objecties

To analyze the clinical symptoms and the outcome of the treatments in the 12 patients who had intradural extramedullary tumors.

Summary of Literature review

In order to provide a good prognosis and achieve a satisfactory clinical outcome for the treatment of intradural extramedullary tumors, early diagnosis and careful surgical resection is necessary.

Materials and Methods

Twelve cases of intradural extradmedullary tumors were treated surgically from September 1990 to July 2000. Of the 12 cases, 7 were male and 5 were femal. A verage followup period was 37 months. Mean age of the cases was 48.3 years. The followings were analyzed; 1)histopathologic diagnoses, 2)locations of tumors, 3)clinical findings, 4)duration of symptoms, and 5)radiologic findings. In addition, both changes of symptoms as well as neurologic findings during the preoperative stage and the postoperative followup were evaluated according to the Frankel's and Kim’s criteria.

Results

Histiopathologic results were as follows; 6 cases (50%) confirmed as schwannoma, 3 cases (25%) as meningioma, 1case as epidermoid cyst, 1 case as neurofibroma, and 1 case as arachnoid cyst. Locations of tumors were as follows; 6 cases (50%) located in the thoracic region, 4 cases (33%) located in the lumbar, 1case located in the cervical region, and 1case located in the sacrum. Clinical findings were as follows: 6 cases complained of back pain and radiating pain to leg, 6 cases noticed motor weaknesses and sensory changes of varying degrees. The average duration from initial symptoms to admission was 57 months (23- 140 months). Laminectomy and complete resection of tumors were performed in all cases. Posterior spinal fusion with instrumentation was necessary only in one case. The preoperative Frankel's grades were as follows; 6 cases were in grade C, 4 cases in grade D, and 2 cases in grade E. A t the final followup, all cases were graded as E.

Conclusion

The Early diagnosis and careful surgical resection for intradural extramedullary tumors provide for a good prognosis as well as a positive clinical outcome. Intradural tumors should be included in the differential diagnosis of spine diseases and considered as a subdivision of orthopaedic spine surgery.

Keywords: Intradural, Extramedullary, Tumor

REFERENCES

1). Cheng MK. Spinal cord tumors in the People's Republic of China: a statistical review. Neurosurg. 10:22–24. 1982.
2). Cushing H, Eisenhardt L. Meningiomas: their classification, regional behavior, life history, and surgical end results. Springfield: Charles C Thomas;p. 735. 1938.
3). Connoly ES. Spinal cord tumors in adults. (in: Youmans JR eds. Neurological surgery. 2nd ed.Philadelphia: WB Saunders Co;p. 3196–3214. 1982. .).
4). Dancy WE. The diagnosis and localization of spinal cord tumors. Ann Surg. 81:222–254. 1925.
5). Elsberg CA. Tumors of the spinal cod and symptoms of irritation and compression of the spinal cord and nerve roots. pathology, symptomatology, diagnosis and treatment. New York: Paul B. Hoeverg;p. 206–239. 1925.
6). Greenwood J Jr. Surgical removal of intramedullary tumors. J Neurosurg. 26:276–283. 1967.
crossref
7). Harry N. The spine. 4th ed. Philadelphia: WB Saunders Co;1366. 1998.
8). Horsley V, Gowers WR. A case of tumor of the spinal cord. Trans Roy Med Chir Soc Glag. 70:377–378. 1888.
9). Kim SS, Denis F, Lonstein JE, Winter RB. Factors affecting fusion rate in adults spondylolisthesis. Spine. 15:979–984. 1990.
10). Nittner K. Spinal meningiomas, neurinomas, and neu -rofibroma-hourglass tumors. Handbook of Clinical Neurology. 20. Amsterdam: North-Holland Publishing Co;p. 177–322. 1976.
11). Sicard JR, Forester J. Methode radiographigue dex -ploration de la cavite epidurale lipiodol, Rev Neurol. 28:1264. 1921.
12). Simeone FA. Spinal cord tumors in adult. (in: Yomans JR eds. Neurological surgery. 3rd ed.Philadelphia: WB Saunders Co;p. 3531–3547. 1990. .).
13). Steinke CR. Spinal tumors: statistics on a series of 330 collected cases. J Nerv Ment Dis. 47:418–426. 1918.
crossref
14). Vinken PJ, Bruyn GW. Handbook of clinical neu -rology. Tumors of the spine and spinal cord. New York: American Elsevier Publishing Co;Part 2,. 20:p. 238–289. 1976.

Figures and Tables%

Fig. 1-A.
T1-weighted sagittal MR image shows peripheral iso-signal intensity and central low signal intensity mass. The tumor is located at the C4-5 level with extension of the tumor forming a dumbbell shaped mass. Fig. 1-B. Gadolinium enhanced T1-weighted sagittal MR image shows marginal enhancement of homogenous high signal intensity mass. Fig. 1-C. Gadolinium enhanced T1-weighted axial MR image shows a dumbbell shape intradural extramedullary mass compressing spinal cord to the left side. Fig. 1-D. Cross section of the tumor showing a well encapsulated ovoid mass measuring 1.8× 1.1× 0.5 cm (0.94 g). Fig. 1-E. The tumor is composed of spindle cells with nuclear palisading and shows vascular hyalinization (H-E stain, × 200). These findings are compatible with schwannoma.
jkss-9-230f1.tif
Fig. 2-A.
T1-weighted sagittal MR image shows peripheral iso signal intensity and low signal intensity mass. The tumor is located at the T9-10 level. Fig. 2-B. Gadolinium enhanced T1-weighted sagittal MR image shows marked enhanced of peripheral portion of the mass. Fig. 2-C. T2-weighted axial MR image shows a well demarcated homogenous high signal intensity mass. Fig. 2-D. Cross section of the tumor showing a bean shape mass measuring 2× 1× 0.5 cm (1.89g). Fig. 2-E. Microscopic findings of the tumor show syncytial appearance, intranuclear pseudoinclusions, and psam-moma bodies(H-E stain, × 200). Histologic diagnosis is meningioma.
jkss-9-230f2.tif
Table 1.
Analysis of intradural extramedullary tumor
No. S/A Diagnosis Level Symptom involvement Onset of symptom Chief complaints Op name Frankel grade Pain Motor deficit Sensory deficit Follow up(month) Result
preop postop preop postop preop postop preop postop
1 F/62 mengingioma T10-T11 Lt 84 MW∗, P† L & EB С E - - + - + - 60 Excellent:
2 M/37 schwannoma T12 Lt 84 Bp† RP† L & EB C E + - + - + - 140 Excellent
3 F/46 schwannoma SI Lt 12 MW, P L & EB C E + + - - + - 28 Poor
4 M/13 epidermoid cyst L3-4 Rt 7 BP, RP L & EB D E + - - - + - 41 Excellent
5 F/50 schwannoma L3-4 132 BP, RP L & EB L & EB E E + - - - - - 49 Good
6 M/39 neurofibroma L4 120 BP, RP PUF∗∗ &CD D E + - - - - - 71 Good
7 M/75 schwannoma C5-6 Rt 6 RP L & EB C E + - + - + - 32 Good
8 F/39 meningioma T9 Lt 3 MW, P L & EB D E - - + - + - 23 Excellent
9 M/61 arachnoid cyst L4-5 Lt 3 MW, P L & EB C E + - + - + - 62 Excellent
10 M/54 meningioma T10-T11 Bilat 360 MW, P L & EB C E - - + - + - 53 Good
11 F/56 schwannoma T 8-9 120 BP, RP L & EB E E + - - - - - 69 Excellent
12 M/48 schwannoma T9-12 Bilat 84 MW, P L & EB D E - - + - + - 50 Excellent

∗ Motor weaknes

† Paraparesis

† Back pain

Radiating pain

|| Laminectomy, Excision & Biopsy

∗∗ Posterior lumbar interbody fusion

†† CD instrumentation

TOOLS
Similar articles