Clinical Characteristics and Surgical Results of Spinal Intradural Tumor

Whoan Jeang Kim; Je Yun Koo; Kyoung Wan Bae; Jong Won Kang; Kun Young Park; Sung Il Kang; Won Sik Choy

doi:10.4184/jkss.2011.18.2.43

Journal List > J Korean Soc Spine Surg > v.18(2) > 1075958

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Koo, Bae, Kang, Park, Kang, and Choy: Clinical Characteristics and Surgical Results of Spinal Intradural Tumor

Original Article

Journal of Korean Spine Surg 2011;18(2):43-50.

Published online: 21 March 2011

DOI: https://doi.org/10.4184/jkss.2011.18.2.43

Clinical Characteristics and Surgical Results of Spinal Intradural Tumor

Whoan Jeang Kim, M.D., Je Yun Koo, M.D., Kyoung Wan Bae, M.D., Jong Won Kang, M.D., Kun Young Park, M.D.^∗, Sung Il Kang, M.D.^†, Won Sik Choy, M.D.

Department of Orthopaedic Surgery, Eulji University School of Medicine

^∗Daejeon Veterans Hospital

^†Hongseong Medical Center

Corresponding author: Whoan Jeang Kim, M.D. Department of Orthopaedic Surgery, Eulji University College of Medicine, 1306, Dunsan-dong, Seo-gu Daejon, 302-799, Korea TEL: 82-42-611-3279, FAX: 82-42-259-1289 E-mail: hjkim@eulji.ac.kr

Received 1 September 2010 Revised 19 April 2011 Accepted 25 April 2011

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

A retrospective study about spinal intradural tumor.

Objectives

We analyzed clinical symptom, findings of MRI, and surgical outcome of spinal intradural tumor.

Summary of Literature Review

Intradural tumors are not commonly reported and they show non-specific clinical features.

Materials and Methods

In this study, 18 patients who underwent surgical treatment and radiologically and pathologically diagnosed as spinal intradural tumor from 1997 to 2009 were reviewed. We evaluated pain, neurological symptoms, location of tumor as well as degrees of signal intensity and its enhancement of MRI(T1 and T2). And clinical outcomes were analyzed according to Klekamp-Samii scoring system and Visual Analogue Scale(VAS).

Results

All patients were clinically suffered from back pain and radiating pain of lower extremity including 3 patients with neurological symptoms. We radiologically found single tumor in 16 cases and masses more than two lesion in 2 cases. 1 case was located on cord level(T7), 14 cases cauda equine level, and 3 cases sacral level. We performed laminectomy in 18 cases and posterior instrumentation was applied to 8 cases. In clinical features, mean Klekamp-Samii score was improved from 21.6 to 23.5(p<0.05) and VAS was recovered from 5.2 to 3.0 (p<0.05).

Conclusions

Spinal intradural tumor has non-specific clinical symptoms. Therefore we should perform MRI to find intradural tumor and active management including surgical treatment should be performed due to clinically good results.

Keywords: Spinal intradural tumor, MRI, Clinical symptom

REFERENCES

1. Ahn SJ, Song MH, Yoo SH, Lee MS, Kang SW, Kim BJ. Solitary intradural metastatic tumor from renal cell carcino-ma. A case report. J Korean Soc Spine Surg. 2009; 16:299–303.

2. Ha KY, Ryoo SJ, Lee JS, Cho YH. Distant intradural metastasis by direct seeding through dural opening from the metastasis of rectal cancer. J Korean Soc Spine Surg. 2005; 12:83–6.

3. Van Goethem JW, van den Hauwe L, Ozsarlak O, De Schepper AM, Parizel PM. Spinal tumors. Eur J Radiol. 2004; 50:159–76.

4. Conti P, Pansini G, Mouchaty H, Capuano C, Conti R. Spinal neurinomas: retrospective analysis and longterm outcome of 179 consecutively operated cases and review of the literature. Surg Neurol. 2004; 61:34–43.

5. Klekamp J, Samii M. Surgical results for spinal meningiomas. Surg Neurol. 1999; 52:552–62.

6. el-Mahdy W, Kane PJ, Powell MP, Crockard HA. Spinal intradural tumours: Part I–Extramedullary. Br J Neurosurg. 1999; 13:550–7.

7. Shin BJ, Lee JC, Yoon TK, et al. Surgical treatments of intradural extramedullary tumor. J Korean Soc Spine Surg. 2002; 9:230–7.

8. Jinnai T, Koyama T. Clinical characteristics of spinal nerve sheath tumors: analysis of 149 cases. Neurosurgery. 2005; 56:510–5.

9. Friedman DP, Tartaglino LM, Flanders AE. Intradural schwannomas of the spine: MR findings with emphasis on contrast-enhancement characteristics. AJR Am J Roent-genol. 1992; 158:1347–50.

10. Roux FX, Nataf F, Pinaudeau M, Borne G, Devaux B, Meder JF. Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol. 1996; 46:458–63.

11. Gezen F, Kahraman S, Canakci Z, Beduk A. Review of 36 cases of spinal cord meningioma. Spine (Phila Pa 1976). 2000; 25:727–31.

12. Harry N. The spine. The textbook of spinal surgey. 4th. Philadelphia: WB Saunders Co;1998. p. 1366.

13. Stein BM, McCormick PC. Intramedullary neoplasms and vascular malformations. Clin Neurosurg. 1992; 39:361–87.

14. Kane PJ, el-Mahdy W, Singh A, Powell MP, Crockard HA. Spinal intradural tumours: Part II–Intramedullary. Br J Neurosur. 1999; 13:558–63.

15. Miller DC. Surgical pathology of intramedullary spinal cord neoplasms. J Neurooncol. 2000; 47:189–94.

16. Traul DE, Shaffrey ME, Schiff D. Part I: spinal-cord neo-plasms-intradural neoplasms. Lancet Oncol. 2007; 8:35–45.

17. Cushing H, Eisenhardt L. Meningiomas: their classification, regional behavior, life history and surgical end results. 1st. Ilinois, Spingfield: Charles C Thomas;1938. p. 735.

18. McCormick PC. Anatomic principles of intradural spinal surgery. Clin Neurosurg. 1994; 41:204–23.

Figures and Tables%

Fig. 1.

Anteroposterior(A) and lateral(B) radiographs show non-specific findings.

Fig. 2.

There are well-defined masses lesion with intermediate signal intensity on both T1(A) and T2 weighted images(B) at the level of L1 and L4, re-spectively. The lesions show homogenous, strong enhancement(C).

Fig. 3.

Intraoperative photograph shows totally encapsulated intradural mass(A). Two encapsulated tumors are resected from different locations(B, C).

Fig. 4.

Histopathologic findings show excised mass consists of Antony A and Antony B type portions.

Fig. 5.

Enhanced MRI show schwannoma with peripheral enhancement on sagittal (A) and axial(B) images.

Table 1.

Klekamp-Samii neurological scoring system.

Score	Sensory deficit	Motor weakness	Gait ataxia	Bladder function	Bowel function
5	No symptoms	Full power	Normal	Normal	Normal
4	Present, not significant	Movement against resistance	Unsteady, no aid	Slight dist, no catheter	Slight dist, control
3	Significant, function not restricted	Movement against gravity	Mobile with aid	Residual, no catheter	Laxatives, control
2	Some restriction of fuction	Contraction without movement	Few steps with aid	Ready incontinent	Rarely, Incontinent
1	Severe restriction of function	Contraction without movement	Standing with aid	Often catheter	Often, incontinent
0	Incapacitated function	Plegia	Plegia	Permanent catheter	Permanent incontinence

Table 2.

Intradural spinal cord neoplasms.

Extramedullary tumors	Intramedullary tumors
Neuroepithelial tumors	Neuroepithelial tumors
Ependymal myxopapillary ependymomas	Astrocystic astrocytomas
Other CNS tumors	Ependymal ependymomas
Meningial meningiomas	Oligodendroglialoligodendrogliomas
Benign mesenchymal lipomas	Mixed neuronal-glial gangliomas
Malignant mesenchymal hemagiopericytomas	Embryonal neuroblastomas
Tumors of spinal nerves	Other CNS tumors
Nerve sheath schwannomas	Benign mesenchymal lipomas
Nerve sheath neurofibromas	Germ cell teratomas
Local extension of regional tumors	Uncertain hemangioblastomas
Paragangliomas	Vascular malformations
Tumor-like cysts	Vascular malformations
Dermoid	Capillary hemangiomas
Epidermoid	Cavernous hemangiomas

TOOLS

Similar articles