Intradural extramedullary spinal tumor [Neurosurgery Wiki]

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====== Intradural extramedullary spinal tumor ======

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While [[intradural]] extramedullary spinal disease varies widely, identification of tumors in this location and their radiologic manifestations greatly facilitates narrowing of the diagnostic considerations. 

===== Epidemiology =====

[[Spinal meningioma]] and [[spinal schwannoma]] are the two most common intradural extramedullary [[spinal tumor]]s, and both are associated with [[neurofibromatosis]]. 

===== Classification =====

see [[Intradural extramedullary spinal tumor differential diagnosis]].

===== Clinical features =====

==== Symptoms Related to Compression and Mass Effect ====

   - **Pain:** The most common initial symptom, often localized or radicular, worsens at night or with Valsalva maneuvers.
   - **Radiculopathy:** Due to nerve root compression, causing dermatomal pain, paresthesia, or weakness.
   - **Myelopathy:** If the tumor compresses the spinal cord, leading to progressive weakness, spasticity, and sensory disturbances.

==== Motor and Sensory Deficits ====

   - **Weakness:** Initially subtle, progressing to significant paresis or paralysis.
   - **Hypoesthesia or Hyperesthesia:** Segmental sensory loss or dysesthesia depending on the affected level.
   - **Gait Ataxia:** Common in cervical and thoracic lesions due to corticospinal tract involvement.
   - **Bowel and Bladder Dysfunction:** Especially with tumors in the thoracolumbar region causing sphincter disturbances.

==== Specific Features by Tumor Type ====

   - **Meningiomas:** More common in middle-aged women, slow-growing, causing gradual myelopathy.
   - **Schwannomas & Neurofibromas:** Typically present with radicular pain, can be part of **NF2** or sporadic.
   - **Ependymomas (Myxopapillary in the filum terminale):** Associated with cauda equina syndrome and lower extremity weakness.

==== Late-Stage Findings ====

   - **Severe Motor Impairment:** Progressive paraplegia or quadriplegia.
   - **Loss of Reflexes:** Depending on the level of compression (hyperreflexia if upper motor neuron, hyporeflexia if lower motor neuron).
   - **Autonomic Dysfunction:** Including erectile dysfunction and urinary retention.


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===== Diagnosis =====

[[Intradural extramedullary spinal tumor diagnosis]].

===== Differential Diagnosis =====

[[Intradural extramedullary spinal tumor differential diagnosis]]

===== Case series =====

[[Intradural extramedullary spinal tumor case series]].

===== Treatment =====
[[Intradural extramedullary spinal tumor treatment]].