Spine tumors 4 - Intradural Extramedullary Lesions

Lesions that occur within the thecal sac are categorized as intradural extramedullary lesions. The vast majority of these lesions are tumors. The most common are schwannomas (and other nerve sheath tumors) and meningiomas, but there are others that include ependymoma, metastatic disease, and lymphoma. Also remember that the intradural extramedullary space contains cerebrospinal fluid (CSF), so any process that diffusely affects CSF can affect this space.
0:28 Introduction
1:26 Peripheral nerve sheath tumors are a group of benign and malignant nerve tumors including schwannomas and neurofibromas. These can expand the neural foramen and usually have well defined margins. Schwannomas tend to enhance a lot while neurofibromas enhance less. Sarcoidosis is another common granulomatous disease that can affect the cord. The most common appearance is T2 abnormality within the cord with some enhancement. Enhancement is often along the surface of the cord.
2:41 Neurofibromatosis is a genetic syndrome with two types, type 1 and type 2. NF type 1 is characterized by multiple plexiform (involving more than one adjacent nerve root) neurofibromas. If neurofibromas increase in size rapidly, have necrosis, or cause pain, that can be a sign of malignant degeneration. NF type 2 is characterized by multiple masses including schwannomas, meningiomas, or ependymomas. NF type 2 is sometimes called MISME syndrome.
4:21 Schwannomas are probably the most common intradural extramedullary lesions. They are well defined lesions with avid enhancement. They often have central non-enhancement or cystic degeneration, but calcification or hemorrhage are less common.
5:30 Case 1 - Meningioma. Meningiomas are well demarcated intradural lesions which occur along the dura and deflect the spinal cord. They enhance avidly and usually don’t have necrosis. They frequently calcify, which you may appreciate more on CT. If they are more elongated and plaquelike they may be referred to as “en plaque” menigiomas. They can cross the dura and have components outside the dura as well.
7:40 Case 2 - Myxopapillary ependymoma. Myxopapillary ependymomas are relatively common tumors that occur around the conus and cauda equina. They usually enhance avidly. Necrosis or hemorrhage are more common than in schwannomas. They were previously grade 1 tumors but have been upgraded to grade 2 because they frequently recur.
10:37 Leptomeningeal metastases are a consideration anytime you see multiple intradural nodules. In adults, these are most commonly from the most common tumors such as melanoma, lung, and breat cancer. Lymphoma can also occur along the cauda equina. In pediatric patients you should also think about intracranial tumors that spread in the CSF, like medulloblastoma, pineal
12:54 Case 3 - Paraganglioma. Spinal paragangliomas are rare spine tumors that have a lot of abnormal surrounding vessels and are prone to hemorrhage. Think about them anytime you see an enhancing tumor in the spine with a lot of flow voids. The other thing you might think about is a hemangioblastoma, but they are more likely to be cystic.
15:02 Case 4 - Lipoma. Fat containing lesions along the conus are common and can be lipomas or dermoids. Clues are fat-suppression of FS images, chemical shift artifact, and fat density on CT. If it is thin and linear along the filum terminale, it is likely a benign fatty filum terminale.
16:36 Summary. Intradural extramedullary lesions are among the most common spinal lesions and it is important to have a clear differential when you see them.
Check out this video and additional content on www.learnneuroradiology.com

[@skeletopedia3122]

Excellent overview!! Thank you Doc.

[@caiyu538]

This lymphoma case really increase my horizon. Great to know it can be looked like this way. Thank you for sharing your great experiences. Many cases widen my knowledge horizon. Enjoy your great tutorials and learn a lot.

[@caiyu538]

Always learn a lot from your tutorials.

[@frankrobert9199]

excellent teacher.

[@LearnNeuroradiology]

Thank you! 😃

[@vishnutoona161]

I just had IDEM D12 surgery Thank you very much for great information

[@LearnNeuroradiology]

No problem! Thanks for tuning in.

[@sylvia7783]

Love these cases and brief summary!

[@LearnNeuroradiology]

Thanks for tuning in!

[@hanyelbanna3673]

Another wonderful work Many thanks May Allah bless you

[@LearnNeuroradiology]

Many many thanks

[@pradnyaalne760]

Thank you sir for concise video 🙏

[@LearnNeuroradiology]

Most welcome

[@guardiaogabriel509]

Devia falar mais devagar a legenda fica insuportável com essa velocidade na fala.

[@LearnNeuroradiology]

Ah, I see why you might have trouble keeping up, especially if you are reading the subtitles. However, I have an easier suggestion for you. When watching on youtube, if you go down to the gear on the bottom right, you can change the playback speed and watch the video slower. There are some pre-selected options, but if you choose custom, you can watch it at 0.8 or 0.9 speed which should still be pretty watchable and give you more time to read the subtitles. support.google.com/youtube/answer/7509567 Another option is if you hit the little ellipsis (three dots) below the video and next to the save button, you can click "Show transcript" where you can see all the subtitles at once along the right side. support.google.com/youtube/answer/100078

[@fallonwatts7228]

I just had this

[@LearnNeuroradiology]

Sorry to hear you had a spine tumor. Sending you best wishes for a speedy recovery!

[@thiruvetti]

Hi sir, my mom of >70 yrs old with history of Diabetes+BP had a partial hip surgery recently. While recovering through physiotherapy we saw very low progress. So we took an MRI and in report it was mentioned that she had IDEM D10 in spine with comment "meningiomas/neurofibroma". I would like to know how serious is this given she just had a surgery. Are these tumors dangerous or can be cured without surgery??

[@LearnNeuroradiology]

That's not really enough information for me to tell you that. You'll have to ask her doctors for more specific information.

[@thiruvetti]

@@LearnNeuroradiology Sorry for that. What I was looking for is guidance not xact diagnosis. Given her age, and the fact that she is recovering from partial hip replacement surgery, we have to do another surgery to remove the neurofibroma tumor from her spine. Assuming we remove it by surgery, will it take a huge toll on her body given 2 surgeries in space of 2 months or it will only make her better?? Just curious.. Ofcourse we are consulting local doctors.

[@LearnNeuroradiology]

@@thiruvetti Yeah that's a tough question. Neurofibromas usually aren't too aggressive so they might want you to wait until she fully recovers from the other surgery. Good luck!