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J Clin Neurosci 2018 Dec 13;58:210-212. Epub 2018 Oct 13.

University of California San Francisco, Department of Neurological Surgery, San Francisco, CA, USA. Electronic address:

Background And Importance: Advances in minimally invasive (MIS) and mini-open surgical approaches have led to reductions in perioperative morbidity without compromising rates of resection of non-degenerative intradural spinal pathologies. Whether these approaches may be adapted for the surgical resection for intramedullary vascular malformations - such as cavernous malformations (CMs) - has yet to be reported. The authors describe a mini-open transspinous approach to resect a ruptured intramedullary CM of the conus medullaris. Read More

World Neurosurg 2019 Jan 11;121:156-159. Epub 2018 Oct 11.

Department of Neurological Surgery, University of California, San Francisco, California, USA.

Background: Intradural intramedullary lipomas without dysraphism are rare tumors. Although they appear extramedullary on imaging, they invade into the intramedullary substance of the spinal cord. We present 2 cases and discuss their clinical presentation, radiologic findings, and surgical management. Read More

Continuum (Minneap Minn) 2018 Apr;24(2, Spinal Cord Disorders):474-496

Purpose Of Review: This article discusses the diagnosis and management of neoplasms that affect the spinal cord as well as spinal cord disorders that can occur due to cancer treatments.

Recent Findings: Neoplastic myelopathies are uncommon neurologic disorders but cause significant morbidity when they occur. Primary spinal cord tumors can be classified into intramedullary, intradural extramedullary, or extradural tumors. Read More

Phys Med Rehabil Clin N Am 2017 02;28(1):101-114

Department of Neurology, Rehabilitation Medicine Service, Memorial Sloan Kettering Cancer Center, Sillerman Center for Rehabilitation, 515 Madison Avenue, 5th Floor, New York, NY 10022, USA; Division of Rehabilitation Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA. Electronic address:

Spinal tumors are classically grouped into 3 categories: extradural, intradural extramedullary, and intradural intramedullary. Spinal tumors may cause spinal cord compression and vascular compromise resulting in pain or neurologic compromise. They may also alter the architecture of the spinal column, resulting in spinal instability. Read More

J Clin Neurosci 2016 Nov 28;33:221-225. Epub 2016 Aug 28.

Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address:

Spinal tumors are conventionally differentiated based on location in relation to the spinal cord. Benign spinal tumors such as schwannomas and meningiomas are typically extra-axial (intradural extramedullary) lesions, whereas more aggressive primary spinal tumors such as ependymomas are typically intramedullary masses. Rarely, ependymomas can have both intramedullary and extramedullary components (typically referred to as exophytic ependymomas). Read More

Neuroepidemiology 2016 19;46(1):14-23. Epub 2015 Nov 19.

Department of Surgery, Hx00F4;pital du Sacrx00E9;-Coeur de Montrx00E9;al, Montreal, Que., Canada.

Objective: Intradural spinal hemangioblastoma are infrequent, vascular, pathologically benign tumors occurring either sporadically or in association with von Hippel-Lindau disease along the neural axis. Described in fewer than 1,000 cases, literature is variable with respect to epidemiological factors associated with spinal hemangioblastoma and their treatment. The objective of this study was to evaluate the epidemiology of intradural spinal hemangioblastoma with the Surveillance, Epidemiology and End Results (SEER) database while also presenting an illustrative case. Read More

Global Spine J 2015 Oct 31;5(5):425-35. Epub 2015 Mar 31.

Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States.

Study Design Broad narrative review. Objectives Intramedullary spinal cord tumors (IMSCT) are rare neoplasms that can potentially lead to severe neurologic deterioration, decreased function, poor quality of life, or death. As such, a better understanding of these lesions is needed. Read More

Neurosurgery 2016 Mar;78(3):E466-73

*Departments of Neurosurgery, ¶Pathology, Section of Neuropathology, ‖Neuro-Oncology, #Radiation Oncology, and **Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, Texas; ‡Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina; §Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; ‡‡Current: Department of Neurosurgery, The Keck School of Medicine of the University of Southern California, Los Angeles, California.

Background And Importance: Spinal cord oligodendrogliomas are rare tumors, with a reported incidence varying between 0.8% and 4.7% of all spinal cord tumors and just over 50 cases reported in the literature. Read More

Eur Spine J 2015 May 8;24 Suppl 4:S606-13. Epub 2015 Feb 8.

Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.

Purpose: Hemangiopericytoma is a rare tumor of CNS with potential for recurrence and widespread metastasis, even outside CNS with even rare involvement of spinal cord. This case series presents five patients to evaluate the clinical presentation, radiological features, management, pathology and outcome of spinal hemangiopericytomas.

Methods: Between 2004 and 2013, five patients underwent surgery for spinal hemangiopericytoma. Read More

World Neurosurg 2014 Nov 24;82(5):836-47. Epub 2014 May 24.

Department of Neurosurgery, Acibadem University, School of Medicine, Istanbul, Turkey. Electronic address:

Objective: Clinical characteristics and management of hemangioblastomas of the spinal cord associated with von Hippel-Lindau syndrome have been extensively covered in the literature. This report aims to analyze the characteristics and surgical treatment results of sporadic spinal hemangioblastomas (SSHB).

Methods: This is a retrospective analysis of 14 patients with SSHB (8 men and 6 women) operated on during a span of 23 years. Read More

Br J Neurosurg 2014 Oct 24;28(5):691-3. Epub 2014 Jan 24.

Departments of Neurosurgery, Rush University Medical Center , Chicago, IL , USA.

Disseminated spinal myxopapillary ependymoma (MPE) is extremely rare in adults. We report a 63-year-old man with chronic low-back pain found to have multiple MPEs in the thoracic, lumbar and sacral spine. Diagnostic and management strategies of disseminated MPE are discussed with a review of pertinent literature. Read More

Turk Neurosurg 2013 ;23(5):600-6

Marmara University, Institution of Neurological Sciences, Department of Neurosurgery, Istanbul, Turkey.

Aim: To determine the role of intraoperative ultrasonography (IOUSG) in the surgical management of patients with intradural spinal tumors.

Material And Methods: Twenty-six patients with intradural spinal cord tumors were surgically treated under intraoperative ultrasonographic guidance between January 2007 and May 2011. Guidance with IOUSG was used in 26 patients, of which 14 fourteen had extramedullary and 12 had intramedullary tumors. Read More

Childs Nerv Syst 2013 Sep 7;29(9):1647-55. Epub 2013 Sep 7.

Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3 JH, UK.

Background: Dermoid and epidermoid tumours are related though pathologically distinct entities that can be combined under the term inclusion cysts. Most are of developmental origin and in the spine may be intramedullary, intradural extramedullary or extraspinal in location. The terminology, aetiology, radiology and optimal management of spinal inclusion cysts have been the source of ongoing controversy. Read More

Eur Spine J 2013 May 5;22 Suppl 3:S450-9. Epub 2013 Jan 5.

Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Purpose: Hemangiopericytoma (HPC) is a rare tumor of the central nervous system. Primary spinal occurrence of this tumor is extremely uncommon and cases involving the intramedullary spinal cord are even more rare. The purpose of this study was to explore the clinical features, surgical strategies, outcome and pathology in a consecutive series of patients treated at a single institution. Read More

J Neurosurg Spine 2011 Jul 15;15(1):28-37. Epub 2011 Apr 15.

Columbia University College of Physicians and Surgeons, Department of Neurological Surgery, New York, New York, USA.

Objective: Access to the ventral intradural spinal canal may be required for treatment of a variety of lesions affecting the spinal cord and adjacent intradural structures. Adequate exposure is usually achieved through a standard posterior laminectomy or posterolateral approaches, although formal anterior approaches are used to access lesions in the subaxial cervical spine. Modifications of the standard posterior exposure as well as ventral or ventrolateral approaches are increasingly being used for treating intradural spinal pathologies. Read More

Neurosurg Focus 2009 Dec;27(6):E10

Department of Neurosurgery, CHA University, Pochon, Republic of Korea.

Object: Stereotactic radiosurgery (SRS) has become an important treatment alternative to surgery for a variety of spinal lesions. However, the use of SRS in the management of intradural intramedullary (IDIM) metastasis remains controversial. The aim of this study was to determine the clinical efficacy and safety of SRS for treatment of IDIM metastasis. Read More

Rev Neurol Dis 2009 ;6(2):E54-61

Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA.

Intramedullary spinal cord hemorrhage (hematomyelia) is an uncommon cause of myelopathy and can present in an acute, subacute, stepwise, or chronic fashion. Spinal vascular malformations such as intramedullary cavernomas and intradural arteriovenous malformations are the most common cause of atraumatic intramedullary spinal cord hemorrhage based on the existing literature. Additional considerations include warfarin or heparin anticoagulation, hereditary or acquired bleeding disorders, primary spinal cord tumors, spinal cord metastases, Gowers' intrasyringal hemorrhage, or a delayed complication of spinal radiation. Read More

Acta Neurochir (Wien) 2009 Mar 25;151(3):277-84. Epub 2009 Feb 25.

Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India.

Background: Primary spinal cord germ cell tumour is a rare tumour. We herein review the tumour characteristics, associated risk factors, treatment policy, and patterns of failure of primary intradural germ cell tumour.

Method: We conducted a PUBMED search using a combination of keywords such as "spinal germ cell tumor," "germinoma," "extradural," "intradural," "intramedullary," "extramedullary," and identified 19 cases of primary spinal germ cell tumour. Read More

Spine J 2008 Nov-Dec;8(6):1030-6. Epub 2007 Aug 10.

Department of Neurosurgery, Bakirköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey.

Background Context: Although the hemilaminectomy technique is known to neurosurgeons performing spinal surgery, laminectomy traditionally has been used during spinal canal surgery for extirpation of spinal cord tumors.

Purpose: Although the technique of unilateral partial hemilaminectomy is familiar in its various permutations to surgeons, its application in the spinal tumor surgery has been rarely reported. The aim of this study was to review the literature about the management of spinal cord ependymomas and to discuss the major controversies in treatment. Read More

Surg Neurol 2008 Mar 4;69(3):314-7. Epub 2007 Sep 4.

Post Graduate Institute of Neurological Surgery, Dr Achanta Lakshmipathi Neurosurgical Centre, VHS Hospital, Chennai 600113, India.

Background: Lipomas of the spinal cord are often a component of spinal dysraphic states. Nondysraphic intramedullary spinal cord lipomas are rare, and concomitant isolated cervical and lumbar intradural intramedullary lipomata are very rare. One patient with concomitant isolated nondysraphic cervical and lumbar spinal cord lipomata has been reported and management options discussed. Read More

Childs Nerv Syst 2008 Feb 18;24(2):219-23. Epub 2007 Jul 18.

Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, NY, USA.

Object: Spinal cord tumors represent approximately 10-20% of primary central nervous system tumors. Only 20-30% of primary intradural tumors are intramedullary. The incidence of longitudinally extensive tumors involving the cervical, thoracic, and lumbar spine is very low (<1% of intramedullary lesions); hence, little literature exists on the management of this entity. Read More

Vet Radiol Ultrasound 2005 Sep-Oct;46(5):368-74

Department of Clinical Sciences, Section of Medicine, Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA.

The records of four dogs with cervical spinal cord meningiomas were retrospectively reviewed. Signalment, history, laboratory findings, neurological examination, and histopathological findings were evaluated. Magnetic resonance imaging (MRI) was performed using a 1. Read More

J Spinal Disord Tech 2005 Oct;18(5):449-54

Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, 21287, USA.

Background: The English literature describes only four cases of intraspinal tumors requiring surgical intervention in the form of cordectomy; none of these cases was for meningiomas. Intraspinal meningiomas, typically extramedullary-intradural, require treatment in the form of resection with dural margin excision. The presentation of an intramedullary atypical World Health Organization grade II meningioma is rare. Read More

Med Princ Pract 2005 Sep-Oct;14(5):354-7

Department of Radiation Oncology, Hamilton Regional Cancer Centre, Hamilton, Canada.

Objective: Hemangioendotheliomas (HE) are vascular neoplasms that rarely involve the neuraxis. We report a rare case in the literature of intradural HE of the spinal cord with intramedullary extension.

Clinical Presentation And Interventions: A 41-year-old gentleman presented with low back pain, numbness and urinary retention. Read More

J Neurooncol 2004 Aug-Sep;69(1-3):291-318

Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA.

The management of patients with intradural spinal tumors differs in many respects from approaches taken for patients with intracranial tumors. Intramedullary lesions are often completely surrounded by normal spinal cord, displacing vital functional tracts eccentrically. Extramedullary lesions can drastically compress the spinal cord and nerve roots, reducing normal tissue to a ribbon-like consistency. Read More

Neurourol Urodyn 2004 ;23(1):68-75

Department of Neurology, Chiba University School of Medicine, Chiba, Japan.

Aims: The objective of this study was to elucidate the incidence and pathophysiology of lower urinary tract dysfunctions (LUTS) in patients with spinal cord tumors.

Methods: Urinary questionnaire and urodynamic studies were done in 76 patients with spinal cord tumors.

Results: The patients included 56 with cervical-thoracic (C1 to T11) and 20 with lumbosacral tumors. Read More

Surg Neurol 2003 Jul;60(1):49-55; discussion 55-6

Department of Neurological Surgery, University of Southern California, 1200 North State Street, Room #5046, Los Angeles, CA, USA.

Background: Idiopathic arachnoid cysts are rare lesions not associated with trauma or other inflammatory insults. To date, there have been few large series describing the presentation and management of these lesions.

Methods: Twenty-one cases of intradural spinal arachnoid cysts were identified (1994-2001). Read More

Br J Radiol 2001 Jan;74(877):15-23

Clatterbridge Centre for Oncology, Clatterbridge Road, Bebington, Wirral CH63 4JX, UK.

It remains unclear whether MRI is essential in all patients with suspected malignant spinal cord compression (MSCC), or whether some patients can be treated on the basis of plain radiographic findings and neurological examination. A prospective study was carried out of 280 consecutive patients with suspected MSCC, and the results of neurological examination plus plain radiographs were compared with MRI. 201 patients had MSCC (186 extradural, 5 intradural extramedullary and 10 intramedullary) and 11 patients had thecal sac compression without evidence of spinal cord compression. Read More

Neurosurgery 2001 Jan;48(1):218-21; discussion 221-2

Division of Pediatric Neurosurgery, Institute for Neurology and Neurosurgery, Beth Israel Medical Center, New York, New York 10028, USA.

Objective And Importance: Intraspinal clear cell meningioma is a rare morphological variant of meningioma. Only 13 case reports are found in the literature; therefore, no management strategy has been defined for this tumor type. This article describes two patients, reviews the literature, and proposes a treatment plan for clear cell meningioma. Read More

Clin Radiol 2000 Nov;55(11):849-55

Department of Diagnostic Radiology, Christie Hospital NHS Trust, Wilmslow Road, Withington, Manchester, UK.

Aim: The aim of this study was to examine the spectrum of spinal canal disease in patients with known malignancy using magnetic resonance imaging (MRI).

Materials And Methods: One hundred and fifty-five patients underwent a total of 159 spinal MRI examinations over a three-year period. Patients were examined using a 1. Read More

Br J Neurosurg 1999 Dec;13(6):558-63

Department of Surgical Neurology, National Hospital for Neurology and Neurosurgery, London, UK.

The results of surgical management in 54 patients with intramedullary spinal cord tumours are presented. Cervical tumours were most frequent (25/54) followed by thoracic (16/54) and then lumbar (14/54). Ependymomas and astrocytomas were the most common tumour types. Read More

Neurosurg Clin N Am 1992 Oct;3(4):947-58

Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York.

Pediatric spinal cord tumors occur in the intramedullary or extramedullary spaces. The extramedullary tumors are further divided into those in intradural-extramedullary or extradural locations. Tumors in the intradural-extramedullary region include nerve sheath tumors, meningiomas, and "embryonal" tumors. Read More

Oncology (Williston Park) 1991 Jul;5(7):25-31; discussion 35-7

Dept. of Neurology, Marshfield Clinic, Wisconsin.

Last month, the author discussed epidural spinal cord compression. This month he describes the incidence, clinical presentation, and management of CNS complications from intradural, extramedullary metastases; leptomeningeal carcinomatosis; intramedullary spinal cord metastasis; paraneoplastic myelopathies; radiation myelopathy, and chemo-induced myelopathy. Read More

Zentralbl Neurochir 1991 ;52(2):49-58

Neurochirurgische Klinik der Heinrich-Heine-Universität Düsseldorf.

This review article delineates the physiology and methodological principles of somatosensory (SEP) and motor evoked potentials (MEP), as well as our own results in 40 patients monitored during spinal surgery. In 29 patients an intraoperative SEP and in 15 patients a MEP monitoring was performed. Both modalities were applied in 4 patients. Read More

Br J Radiol 1989 Dec;62(744):1067-74

Department of Neuroradiology, University Hospital, Queen's Medical Centre, Nottingham.

The use of gadolinium diethylenetriamine-penta-acetic acid (Gd-DTPA) (Magnevist) enhanced magnetic resonance imaging (0.15 T) in the assessment of spinal tumours is described. Thirty-five patients were entered into the study and a total of 39 examinations were performed. Read More

Acta Radiol Suppl 1986 ;369:730-3

Institute of Clinical Radiology, University of Münster, Medical School, West Germany.

Eight patients with either spinal cord hemangioblastomas (n = 5), spinal arteriovenous malformations (AVM) (n = 2) and intramedullary hematoma (n = 1) were studied by magnetic responance (MR) imaging. All hemangioblastomas, one AVM and the intramedullary hematoma were identified by MR. Compared with other neuroradiologic procedures, MR provided important complementary information in the diagnostic management of spinal hemangioblastomas and proved to be a useful method for noninvasive follow-up in these lesions. Read More

Surg Neurol 1984 Sep;22(3):267-72

A 15-year-old black female student came to the hospital because of disturbance of her gait. On examination, there was a dermal sinus in the skin overlying the spine of the seventh cervical vertebra, and myelography with computed tomography scan demonstrated a block to the flow of metrizamide contrast material at T-5 with cephalad extension of an intradural cystic lesion to the C-5 level. An x-ray examination of the abdomen at the time demonstrated a tooth-shaped radiodensity in the left hypogastrium. Read More

Childs Brain 1984 ;11(1):36-46

Pain in children is generally not accorded the same significance by allied health professionals as pain in adults. To some extent this relative neglect may be the result of a general belief that pain is less of a problem in the pediatric age-group. However, it is the author's experience that the management of pain in children with spinal cord tumors reveals the same significance as in adults. Read More

J Neurosurg 1957 Jan;14(1):28-42