martedì 2 ottobre 2007

Spinal meningioma






Findings

Sagittal T1 and T2 sequences demonstrate an intradural extramedullary lesion in the midthoracic region which is soft tissue signal on T1 (Figure 1) and soft tissue signal on T2 (Figure 2). Sagittal T2 images demonstrate CSF capping above and below the lesion, which suggests an intradural extramedullary location.
Post contrast images demonstrate homogeneous enhancement of the lesion (Figure 3). A “dural tail” demonstrating the characteristic broad based dural attachment on post gad images is shown.
Incidentally, multiple hemangiomas are demonstrated on sagittal T2 images (Figure 2).


Diagnosis: Spinal meningioma


When evaluating lesions of the spinal cord, it is important to first determine in which space the lesion is located. Lesions may be intramedullary, intradural extramedullary, or extradural.

Meningiomas are the second most common tumor in the intradural extramedullary compartment (nerve sheath tumors most common). Meningiomas account for around 25% all spinal tumors and usually occur in the thoracic spine (80%). 15% of spinal meningiomas occur within the cervical spine. Occasionally, they may be purely extradural, or bridge both the intradural and extradural compartments.

Spinal meningiomas are usually located lateral or dorsolateral in the spinal canal. Since they are thought to arise from arachnoid cluster cells, their location is at the entry zone of nerve roots or the junction of dentate ligaments and dura mater. The spinal cord is usually compressed and displaced away from the lesion.

MR usually demonstrates an intradural extramedullary location. The lesions are usually isointense to the spinal cord on T1 and T2 or alternatively hypointense on T1 and hyperintense on T2. Immediate, homogeneous contrast enhancement is characteristic. Calcification may be seen. Most spinal meningiomas demonstrate broad-based dural attachment, and may show a “dural tail,” as in this case. The subarachnoid space above and below the lesion is widened, described as CSF “capping” of the lesion from below and above. This finding is important in confirming an intradural extramedullary location.

The mainstay of treatment is surgical resection, depending on the extent of the lesion. When complete resection is not possible, post-operative radiotherapy may be performed. Monitoring of symptoms is important following treatment.


Differential diagnosis for each spinal compartment

1 commento:

  1. There was a time in my youth when I felt immortal.

    I was strong. Healthy. Full of life.

    Maybe like you, I felt like I could conquer the world.

    Every day I'd wake up, bursting with energy. Feeling unstoppable.

    I'd go out and exercise full out. Or put in a long day at work. Or go on a weekend adventure with friends to the mountains.

    And at the end of the day? I'd still feel REALLY good.

    Tired, but in a good, relaxing, "hit the sack" kinda way.

    Until one day, it happened.

    I was getting out of the car and for some reason, I twisted my back.

    It immediately seized up. Hunched over with hand on my hip, my muscles spasmed as if to protect it.

    The pain was sharp. Deep. Crippling.

    That was a day I'll never forget. That was the day I realized... I was human.

    Getting out of the car was something I'd done a thousand times before. Why did it happen THAT day, I wondered?

    I've replayed it a thousand times in my head, but I'll never know.

    What I do know is that day set off a chain reaction of events.

    Over the years, more unexpected bouts of pain. Days and even weeks off work.

    Make-you-feel-like-a-zombie pain pills.

    Physical therapy. Alternative therapy. Chiropractic.

    Days of "bed rest" watching Jerry Springer.

    Oh, I hated that term "bed rest." It's so not me.

    Ever since that fateful day, every so often out of the blue, I'll tweak my back again and relive that fateful day as well as the weeks afterward, nursing it back to health.

    Until recently.

    While I was experiencing my most recent painful bout, one of my business partners took pity and shared with me a wonderful natural method that not only relieves back pain in less than 20 minutes, but there's a strong likelihood you'll never have to deal with it again.

    Imagine that!

    I tried it and amazingly, it worked! Within just a few minutes, my back magically "unlocked." The relief was like a warm south Pacific wave, relaxing every muscle in my body.

    After wasting thousands of dollars on useless remedies, days and weeks off work, I was FINALLY FREE from pain.

    I'll be honest. As I've grown older, my experience with back pain has humbled me. When I look at it the right way, maybe it WAS a good thing, because I no longer take my health and body for granted.

    But the great thing is I'm back doing the things I love. Without giving second thought to whether my back will "go out." With this unique method, it's been months since I've experienced even the smallest inkling of pain...

    ==>Back Pain Relief 4 Life

    All I can say I wish I'd know about this method sooner. But I thank my lucky stars I found it when I did.

    To your health,

    RispondiElimina