Spinal Cord And Root Compression

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MENINGIOMA

Spinal meningiomas tend to occur in elderly patients and are more common in females than in males. They usually arise in the thoracic region and are almost always intradural. Slow growth often permits considerable cord flattening to occur before symptoms become evident. MRI or CT myelography will identity the lesion.

The operative aim is complete removal. Results are usually good, but if the tumour arises anteriorly to the cord, excision of the dural origin is difficult, if not impossible, and recurrence may result.

SCHWANNOMA/NEUROFIBROMA

Schwannomas are slowly growing benign tumours occurring at any level and arising from the posterior nerve roots. They lie either entirely within the spinal canal or 'dumbbell' through the intervertebral foramen, on occasions presenting as a mass in the thorax or posterior abdominal wall.

Neurofibromas are identical apart from their microscopic appearance (page 295) and their association with multiple neurofibromatosis (Von Recklinghausen's disease NFI - see page 540) - look for café au lait patches in the skin.

Schwannomas tend to occur in the 30-60 age group. Typically they present with root pain. Root signs and/ or signs of cord compression may follow.

MRI or CT myelography identifies an intradural/ extramedullary lesion. Oblique X-rays may show foraminal enlargement; CT scan will delineate any extraspinal extension (see page 382). Complete operative removal is feasible but the nerve root of origin is inevitably sacrificed. Overlap from adjacent nerve roots usually minimises any resultant neurological deficit.

Nerve root entering tumour

Nerve root entering tumour

Neurofibroma 'dumbbelling' through intervertebral foramen

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