Intradural Spinal Tumors: Meningioma, Schwannoma, Ependymoma
Intradural spinal tumors grow inside the dura, the tough membrane that holds the spinal cord and its fluid. Most are benign and slow-growing, and most can be cured by removing them. They are divided by where they sit: intradural extramedullary tumors grow beside the cord, from a nerve root or the dural lining (schwannoma, neurofibroma, meningioma); intramedullary tumors grow within the cord itself (ependymoma, astrocytoma, hemangioblastoma).
Because these tumors press on the cord or nerves gradually, symptoms often creep in over months and are easy to attribute to arthritis or a disc. An MRI with contrast usually makes the diagnosis clear. Dr. Daggubati’s neuro-oncology fellowships focused on exactly these tumors, and his approach is to remove them completely with the smallest opening that allows safe microsurgery — and, in most cases, without screws or rods.
Symptoms
- Back or neck pain that is worse at night or lying flat
- Pain in a band around the chest or abdomen (a nerve-root pattern)
- Numbness or tingling that slowly spreads
- Weakness, stiffness or clumsiness in the legs or hands
- Unsteady walking
- Bladder or bowel changes (later)
How it is diagnosed
MRI of the spine with and without contrast, of the whole spine when a tumor is found. Location (beside the cord or within it), enhancement pattern and shape usually identify the tumor type before surgery; the final diagnosis comes from pathology after removal.
Treatment options
Without surgery
Small, asymptomatic tumors found by chance — especially schwannomas and meningiomas in older patients — can be watched with periodic MRI. Radiosurgery is an option for tumors that cannot be removed safely or that recur. Intramedullary tumors that are diffuse (some astrocytomas) are biopsied and treated with radiation or chemotherapy.
Surgical options Dr. Daggubati offers
- Microsurgical removal through a laminectomy or laminoplasty, with nerve monitoring
- Radiosurgery for residual or recurrent tumor
The common intradural tumors
- Schwannoma: the most common; grows from the sheath of a nerve root, usually a sensory root, which can be sacrificed at surgery with little or no deficit. Curable by complete removal.
- Meningioma: grows from the dural lining, most often in the thoracic spine of women over 50. Removed together with its dural attachment or the attachment is coagulated; recurrence is uncommon.
- Neurofibroma: like a schwannoma but grows within the nerve fibers rather than beside them; associated with neurofibromatosis type 1.
- Ependymoma: the most common intramedullary tumor in adults; well-defined, with a plane from the cord that allows complete removal in most cases. Myxopapillary ependymomas occur at the bottom of the spinal canal (filum terminale).
- Astrocytoma: intramedullary, more infiltrative; removal is guided by the tumor’s edge and monitoring, and radiation is often added.
- Hemangioblastoma: a vascular intramedullary tumor, sometimes associated with von Hippel–Lindau disease; removed whole after its feeding vessels are controlled.
Why timing matters
A slowly growing tumor gives the spinal cord time to adapt, which is why symptoms can be mild for a long time. Function that is lost before surgery does not always return, so once a tumor is causing symptoms or is clearly enlarging, removing it sooner protects what you still have. Tumors found by chance that are small and silent can safely be watched.
Common questions
Is an intradural tumor cancer?
Usually not. Schwannomas, meningiomas, neurofibromas and most ependymomas are benign. Astrocytomas vary in grade. Even benign tumors need treatment when they compress the cord, because the damage they do is not benign.
Will I need rods and screws?
Usually not. Removing an intradural tumor means opening the spinal canal from the back, not removing the parts of the spine that carry load. In most patients the bone is either left open (laminectomy) or replaced (laminoplasty) without instrumentation. Fusion is added only when a large amount of bone or a facet joint had to be removed to reach the tumor.
Can the tumor come back?
After complete removal of a schwannoma or meningioma, recurrence is uncommon — a few percent over many years. Follow-up MRI is done at intervals for several years.
Not sure this is you?
Bring your imaging and your story. A single visit usually clarifies what is going on and which options are realistic. Request an appointment or call (301) 718-9611.