Intradural spinal tumors occur inside the spinal sac. They can occur anywhere along the spine and spinal cord: in the neck (cervical), mid-back (thoracic) and/or the lower back (lumbosacral). Spinal tumors can be benign (non-cancerous) or malignant (cancerous).
There are two types of intradural tumors:
- Intramedullary tumors are found inside the spinal cord. These tumors include gliomas, astrocytomas and ependymomas.
- Extramedullary tumors are found outside the spinal cord. These tumors include meningiomas, neurofibromas, schwannomas and nerve sheath tumors.
Signs and symptoms
Spinal tumors can cause the following symptoms:
- Back pain at the tumor’s location
- Loss of function (weakness or paralysis)
- Bowel and bladder dysfunction due to involvement of or pressure on the spinal cord or spinal nerves
The exact cause of intradural tumors is not fully understood. Researchers have found that some of the chemical changes that occur in normal cells may lead to tumors. Most tumors involve abnormalities in genes that control the cell cycle (when cells grow, divide and die). These abnormalities cause uncontrolled cell growth.
Other than exposure to radiation or certain chemicals, there are no known lifestyle-related or environmental causes of intradural tumors.
Other conditions can cause the same symptoms, so it is important to check with your doctor for an accurate diagnosis. Only a doctor experienced in recognizing the exact combination of symptoms that indicate an intradural tumor can make a firm diagnosis.
Diagnosis of an intradural tumor starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose tumors, including magnetic resonance imaging (MRI), computed tomography (CT) and stereotactic biopsy . Stereotactic biopsy is done to make the correct diagnosis and determine possible treatment options.
A customized treatment plan is put together for you based on:
- The tumor’s location and size
- Your age and general health
- Your tolerance for treatment
- Your preferences
Treatment for an intradural tumor may include one or a combination of the following options:
- Observation. If the tumor is not causing issues or symptoms, it can be observed and reevaluated.
- Open microsurgery. Surgery is recommended to improve symptoms, prevent further loss of function and make a diagnosis. Surgery can usually cure benign tumors. Surgery cannot cure malignant tumors, but can help preserve function. This type of surgery requires a highly specialized and meticulous approach and depends on the location of the tumor. This approach involves making an incision, opening the bone and exposing and opening the dural membrane. A microscope or special high-powered loupe (glasses) is used to visualize the tumor and remove it. You will need to stay in the hospital for a few days after surgery, with the length of stay determined by the extent of surgery. You will undergo a MRI with and without contrast after surgery to make sure that complete removal of the tumor has occurred.
- High-dose chemotherapy. During this procedure, very high doses of chemotherapy (medicines designed to treat cancer) are given to the patient, usually by intravenous (IV) line.
- Radiation. This treatment uses high-energy particles or waves to kill cancer cells by damaging their DNA.
Follow-up care includes regular monitoring for worsening of symptoms, effectiveness of treatment and, if the tumor was removed, recurrence of the tumor by means of follow-up MRI studies.