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Spinal Meningioma

Summary

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  • Slow-growing, benign tumours arising from arachnoid cap cells of the spinal meninges
  • Most common intradural extramedullary spinal tumour in adults
  • Typically presents with gradual onset of neurological symptoms due to spinal cord compression1

Pathophysiology

  • Arise from arachnoid cap cells in the spinal meninges
  • Most commonly occur in the thoracic spine (80%), followed by cervical and lumbar regions
  • Grow slowly, causing gradual compression of the spinal cord and nerve roots
  • WHO classification:
    • Grade I (benign): 90% of cases
    • Grade II (atypical): 5-7% of cases
    • Grade III (anaplastic): <1% of cases

Demographics

  • Peak incidence: 40-70 years of age
  • Female predominance (female:male ratio 3-4:1)
  • Account for 25-46% of primary spinal cord tumours in adults
  • Rare in children, comprising <5% of paediatric spinal tumours

Diagnosis

  • Clinical presentation:
    • Gradual onset of neurological symptoms
    • Local or radicular pain
    • Sensory disturbances
    • Motor weakness
    • Gait abnormalities
    • Sphincter dysfunction (in advanced cases)
  • Physical examination:
    • Sensory level deficit
    • Motor weakness below the level of the lesion
    • Hyperreflexia and spasticity
    • Positive Babinski sign

Imaging

  • MRI: imaging modality of choice
    • T1-weighted: iso- to hypointense relative to spinal cord
    • T2-weighted: iso- to hyperintense
    • Strong, homogeneous enhancement with gadolinium
    • "Dural tail" sign often present
    • May demonstrate calcifications (10-20% of cases)
  • CT:
    • Useful for detecting calcifications and bony changes
    • May show scalloping of adjacent vertebral bodies in long-standing cases
  • Plain radiographs:
    • Limited utility, may show bony erosion or widening of neural foramina

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  • A 60-year-old patient presented with low limb sensory disturbance.
  • MRI showed a hypointense lesion with a broad thecal base compressing the thoracic cord.

Treatment

  • Surgical resection, usually curative. It is the commonest intradural-extramedullary tumour, typically a broad-based, dural-tailed, thoracic enhancing mass in a middle-aged woman

Differential diagnosis

Differential Diagnosis Differentiating Feature
Schwannoma Typically eccentric to the spinal cord, often with "dural tail" sign absent
Neurofibroma Dumbbell-shaped expansion through neural foramen; "target sign" on T2; may be multiple
Metastatic tumour Often multiple lesions; may have associated bony involvement; more aggressive bone destruction
Ependymoma Intramedullary location; often with syringomyelia; "cap sign" haemosiderin on SWI
Astrocytoma Intramedullary location; poorly defined margins; irregular enhancement
Lymphoma Homogeneous epidural or intradural mass; restricted diffusion on DWI; may be multiple
Spinal epidural abscess Rim-enhancing collection; restricted diffusion in abscess; cord compression without intradural involvement
Herniated disc Typically at disc level, associated degenerative changes
Arachnoid cyst No enhancement, CSF-like signal on all sequences
Spinal arteriovenous malformation Flow voids on MRI, associated cord oedema

  1. Sadrameli et al. Resection of Spinal Meningioma Using Ultrasonic BoneScalpel Microshaver: Cases, Technique, and Review of the Literature. 2020. Operative neurosurgery (Hagerstown, Md.) - Open in new tab. ↩