A spinal meningioma is a type of tumor that develops in the protective layers surrounding the spinal cord. These tumors grow slowly and are typically benign. While meningiomas can occur in various parts of the central nervous system, those located in the spine comprise a smaller percentage of all meningiomas. Their presence in the confined space of the spinal canal can lead to a range of symptoms as they gradually put pressure on the spinal cord or nerves.
Understanding Spinal Meningiomas
Meningiomas originate from the meninges, the three layers of membranes that protect the brain and spinal cord. They specifically arise from the arachnoid membrane, one of the middle meningeal layers. Most spinal meningiomas are classified as World Health Organization (WHO) Grade 1.
These tumors are relatively uncommon, accounting for a small percentage of all meningiomas and primary spinal tumors. Spinal meningiomas are more frequently observed in women, particularly between the ages of 50 and 70. While the exact cause is not fully understood, exposure to ionizing radiation and a genetic disorder called neurofibromatosis type 2 (NF2) are recognized risk factors. The most common location for spinal meningiomas is the thoracic (mid-back) region, followed by the cervical (neck) area, and they are rarely found in the lumbar (lower back) region.
Common Signs and Symptoms
Spinal meningioma symptoms appear gradually due to the tumor’s slow growth, and they depend on its specific location along the spinal cord. Initial signs can include localized pain at the tumor site, which may radiate to the arms if in the cervical spine, around the chest if in the thoracic spine, or into the legs if in the lumbar spine. As the tumor expands and compresses the spinal cord or nerve roots, various neurological deficits can emerge.
Sensory changes are frequently reported, such as numbness, tingling, or a loss of sensation in the arms or legs. Motor weakness is also a common complaint, potentially starting as slight weakness and progressing to more significant motor deficits or difficulty walking and maintaining balance. In some instances, patients may experience muscle spasms, gait disturbances, or issues with bladder and bowel control. These symptoms are not unique to spinal meningiomas and can sometimes be mistaken for other conditions, making accurate diagnosis important.
Diagnosis and Treatment Options
Diagnosing a spinal meningioma begins with a neurological examination to assess sensory, motor, and reflex functions, which can indicate the affected area of the spinal cord. Imaging studies are the primary tools for confirming the presence and characteristics of the tumor. Magnetic Resonance Imaging (MRI) with a contrast agent is considered the standard for diagnosis, providing detailed images of the tumor’s size, exact location, and its impact on surrounding spinal structures. MRI scans can show how the tumor displaces or compresses the spinal cord and often reveal a “dural tail,” a thickening of the dura mater where the tumor is attached.
Computed Tomography (CT) scans may also be used, particularly if MRI is not feasible due to implanted medical devices, or to identify calcium deposits within the tumor, which are common in meningiomas. While imaging can suggest a meningioma, a biopsy provides definitive confirmation and determines the tumor’s grade. Treatment decisions are tailored to the individual, considering factors such as tumor size, location, symptoms, and the patient’s overall health.
For small, slow-growing spinal meningiomas that are not causing symptoms, a “wait-and-see” approach with regular follow-up MRI scans may be recommended. However, surgical removal is the most common and often preferred treatment, especially for symptomatic or larger tumors. Complete tumor resection is the goal of surgery, often leading to a cure for benign meningiomas. Advanced surgical techniques, including microsurgery and intraoperative monitoring, help to maximize tumor removal while minimizing risk to the spinal cord and nerves.
When complete surgical removal is not possible, either due to the tumor’s location near delicate structures or its invasion into surrounding tissues, radiation therapy may be considered. Radiation therapy, such as stereotactic radiosurgery (SRS), delivers highly focused radiation beams to destroy tumor cells or prevent their growth. It can be used as a primary treatment for small tumors or as an adjuvant therapy after partial surgical removal, particularly for higher-grade tumors (WHO Grade 2 or 3) or if the tumor recurs. Chemotherapy is not a standard treatment for spinal meningiomas, as most do not respond to it.
Prognosis and Recovery
The outlook for individuals with spinal meningiomas is favorable, especially after complete surgical removal of benign tumors. For WHO Grade 1 meningiomas, the 5-year progression-free survival rates are high. Many patients experience significant improvement in their neurological symptoms and overall quality of life following successful treatment.
Recovery time varies depending on the complexity of the surgery and the extent of any prior neurological deficits. While some patients may regain mobility and function within weeks, others may require months of physical and occupational therapy to fully recover. Although rare for benign cases, recurrence is possible, and ongoing follow-up care with regular imaging scans is recommended to monitor for any new tumor growth.