Our Summary

This research paper focuses on understanding different types of tumors that can occur within the protective membrane covering of the spinal cord. The two most common are meningiomas and schwannomas, both of which are linked to a genetic disorder called neurofibromatosis. Meningiomas are more common in women, are usually found in the middle part of the spine, and can cause symptoms related to the compression of the spinal cord or nerves. Schwannomas, on the other hand, are often associated with nerve pain and other sensory symptoms.

The paper also discusses a type of schwannoma that has a unique appearance on MRI scans due to the presence of free radicals in melanin, a pigment found in the human body. Another tumor, known as a neurofibroma, is often found in the upper part of the spine and can be challenging to remove surgically.

A less common but more aggressive tumor that can mimic the appearance of a schwannoma on imaging is the malignant peripheral nerve sheath tumor. In the lower part of the spine, tumors called myxopapillary ependymoma and paraganglioma are believed to arise from a specific part of the spinal cord and have distinctive imaging features.

The paper also highlights the recent identification of a common genetic marker that has led to the reclassification of certain tumors. In certain clinical situations, the presence of a specific type of enhancement on imaging strongly suggests the presence of metastatic disease, which is when cancer cells have spread from their original location, even if the fluid analysis from the spinal cord is negative. The paper emphasizes understanding the distinct imaging features of these tumors to aid in their diagnosis and treatment.

FAQs

  1. What are the two most common intradural extramedullary tumors?
  2. How does melanotic schwannoma appear in MRI imaging?
  3. What does nodular intradural enhancement suggest in a clinical setting?

Doctor’s Tip

A helpful tip a doctor might tell a patient about tumor resection is to make sure to follow all pre-operative instructions provided by the medical team, including fasting guidelines and medication protocols. It is also important to communicate any concerns or questions with the healthcare provider and to have a support system in place for after the surgery. Additionally, following post-operative care instructions, such as wound care and physical therapy, is crucial for a successful recovery.

Suitable For

Patients who are typically recommended tumor resection are those who have intradural extramedullary spinal tumors such as meningioma, schwannoma, neurofibroma, malignant peripheral nerve sheath tumor, myxopapillary ependymoma, paraganglioma, and solitary fibrous tumor/hemangiopericytoma. These tumors can cause compression of the spinal cord or nerve roots, radicular pain, sensory symptoms, and other complications that may require surgical intervention. Additionally, the presence of nodular intradural enhancement may suggest leptomeningeal metastatic disease, which also may require tumor resection. Treatment recommendations are made based on the specific characteristics of the tumor, the patient’s symptoms, and other factors that are taken into consideration by a multidisciplinary team of healthcare professionals.

Timeline

  • Before tumor resection: The patient may experience symptoms related to the location and size of the tumor, such as pain, weakness, sensory changes, or bladder/bowel dysfunction. Diagnostic imaging, such as MRI or CT scans, may be performed to identify the tumor and determine the best course of treatment.

  • Tumor resection: The surgical procedure to remove the tumor is performed by a neurosurgeon. The patient is placed under general anesthesia, and the tumor is carefully removed while preserving surrounding healthy tissue. In some cases, radiation therapy or chemotherapy may be recommended after surgery to prevent recurrence.

  • After tumor resection: The patient will undergo a period of recovery, which may involve pain management, physical therapy, and follow-up appointments with the neurosurgeon. The patient’s symptoms may improve gradually as the body heals from the surgery. Follow-up imaging scans may be performed to monitor for any signs of tumor recurrence.

What to Ask Your Doctor

  1. What type of tumor do I have and what are the characteristics of this specific tumor?
  2. What are the potential risks and benefits of tumor resection surgery?
  3. What is the likelihood of the tumor returning after surgery?
  4. What is the expected recovery time and rehabilitation process after tumor resection surgery?
  5. Are there any alternative treatments or therapies available for my specific tumor?
  6. What are the potential long-term effects or complications of tumor resection surgery?
  7. How often will I need follow-up imaging or appointments after surgery?
  8. Will I need any additional treatments, such as radiation or chemotherapy, after tumor resection surgery?
  9. Are there any lifestyle changes or precautions I should take after tumor resection surgery to prevent recurrence?
  10. Can you provide me with information or resources for support groups or counseling services for patients undergoing tumor resection surgery?

Reference

Authors: Koeller KK, Shih RY. Journal: Radiographics. 2019 Mar-Apr;39(2):468-490. doi: 10.1148/rg.2019180200. PMID: 30844353