Nursing review of spinal meningiomas

Abstract

Background: Spinal meningiomas are found in patients typically between the ages of 75 and 84: some report the average age to be 50. They occur with an incidence of approximately 1000 patients per year in the US, are mostly single (90%) rather than multiple (10%), and arise from the spinal meninges (arachnoid/dura). Tumors are typically posterior/posterolateral (70%) in location, leaving the remaining 30% in the anterior/anterolateral spinal canal. They produce symptoms and signs of radiculopathy (nerve root) and/or myelopathy (cord compression) depending on their site of origin.

Methods: Meningiomas may be single/sporadic (90%) or multifocal. They may arise primarily/spontaneously, can be radiation-induced, or associated with neurofibromatosis. They are found most frequently in females vs. males in up to a 3.4:1 ratio, occur predominantly in the thoracic spine. They are found in decreasing order in the cervical and lumbar spinal canals. The diagnosis of a meningioma is based on magnetic resonance (MR) studies, where tumors are isointense on T1 weighted MR, and hyperintense onf T2-weighted MR images; they also typically uniformly enhance with Gd-DTPA. On computed tomography (CT) examinations, they are usually characterized as calcified/hyperdense.

Results: The neurological deficits resulting from meningiomas and the rapidity of symptom/sign progression dictate whether they are treated surgically or nonsurgically. Management choices include; stereotactic radiation therapy only, and/or in combination with varied surgical resection techniques.

Conclusions: The majority of benign spinal cord tumors are meningiomas (40%) that are predominantly found in the thoracic spine in middle-aged females. Tumor levels (e.g. in descending order cervical, thoracic, lumbar), and their location (e.g. anterior/anterolateral 30%; dorsal/dorsolateral 70%) best determine whether nonoperative, operative, and/or operative intervention combined with routine vs. stereotactic radiosurgery are warranted.

Keywords: CT; Diagnostic studies; MR; locations; prognosis; routine radiation; spinal meningiomas; stereotactic radiosurgery/Cyberknife; surgical techniques; tumors.

Figure 1

Midline sagittal T1-weighted localizing MR scan documenting a meningioma filling the spinal canal at the T8 level. Note the lesion is isointense when compared with the cord

Figure 2

Midline sagittal 2D-CT bone window demonstrating a calcified meningioma with classical "tail" (en-plaque) sign indicating extension along the posterior dura. Note the tumor nearly fills the spinal canal at the T9 level and extends inferiorly to the T9/T10 interspace

Figure 3

Axial bone window thoracic axial CT demonstrating an ossified/calcified meningioma filling two-thirds of the dorsolateral spinal canal centrally and toward the left. Note the homogeneous hyperdense structure of the tumor

Figure 4

Axial thoracic T1 MR without contrast shows an isointense meningioma filling 5/6 of the dorsolateral spinal canal centrally/toward the right side. This results in the cord being compressed ventrally and toward the left side of the canal

Figure 5

Midline sagittal T2-weighted cervical MR scan showing a homogeneous, hypointense lesion filling the spinal canal opposite the C4 vertebral level

Figure 6

Axial soft tissue window CT scan at the C2-C3 level demonstrating inhomogeneous ossification/calcification of a meningioma (combined width some soft tissue/hypointense elements) filling the anterolateral and dorsolateral right side of the spinal canal. There is further central and right foraminal extension. Note the lesions appears to extend all the way from the lamina posteriorly to the disc space ventrally

Figure 7

For the same patient depicted in Figure 6, the right-parasagittal soft tissue window 2D-CT shows the inhomogeneous nature (hyperdense calcification/isodense-soft tissue) of the right central-lateral/foraminal meningioma

Figure 8

Parasagittal 3D-CT taken from the same patient depicted in Figures 6 and 7, demonstrates the right-sided central-foraminal location of the inhomogeneous meningioma, indicating ossification/calcification (hyperdense)

Figure 9

Coronal 3D CT taken from the same patient depicted in Figures 6–8 demonstrates the right-sided central-foraminal location of the inhomogeneous singal within the right-sided, dorsolateral/foraminal menignioma indicating ossification/calcification (hyperdense) with additional soft tissue elements (isodense)

Figure 10

This axial softt-tissue CT demonstrates a uniformly ossified meningioma occupying the entire right side of the cervical spinal canal at the C3-C4 level