Spinal Meningioma
Benign intradural-extramedullary tumor arising from spinal meninges
ICD-10: D32.1 · tumors condition
Spinal meningiomas are benign, slow-growing tumors arising from the arachnoidal cells of the spinal meninges. They account for approximately 25–45% of all intradural spinal tumors and are the second most common intradural-extramedullary spinal tumor after schwannoma. They are most common in women over 50 (female-to-male ratio 4:1) and occur predominantly in the thoracic spine (80% of cases), where they typically arise from the posterior or posterolateral dura. As the tumor grows, it progressively compresses the spinal cord, producing slowly evolving myelopathy. Because growth is indolent, patients often tolerate substantial cord compression before seeking care — gait difficulty is frequently the presenting symptom, months to years after the tumor began growing. Sensory changes, bladder dysfunction, and back pain may also be present. MRI with gadolinium shows a homogeneously enhancing extramedullary intradural lesion with a broad dural base and characteristic "dural tail." Surgical resection via posterior laminectomy is the treatment of choice. Gross total resection is achievable in the majority of cases and provides excellent neurological recovery given the external cord compression mechanism. The degree of neurological recovery correlates with the completeness of resection, duration of pre-operative deficits, and spinal cord signal change on pre-operative MRI. Recurrence rates after gross total resection are less than 5% at 10 years.
Anatomy & Pathology
The spinal meninges consist of three layers: the dura mater (outermost), arachnoid mater (middle), and pia mater (innermost, adhering to the cord). Meningiomas arise from arachnoid cells at the inner surface of the dura. Thoracic tumors typically attach dorsally or dorsolaterally to the dura, compressing the cord from behind. A broad dural attachment ("en plaque" variant) is occasionally seen and increases surgical complexity.
Symptoms
- Slowly progressive leg weakness and spasticity (myelopathic gait)
- Sensory level — band of altered sensation at the level of cord compression
- Gait ataxia and balance difficulty
- Bladder dysfunction: urgency, frequency, or urinary retention
- Back pain at the level of the tumor (often mild or absent)
- Radicular pain if nerve roots are involved at the tumor margins
- Lhermitte sign (electric shock sensation down spine) if cervical involvement
Causes & Risk Factors
- Aracnoidal cell origin — benign proliferation without identifiable carcinogen
- Prior spinal irradiation (radiation-induced meningioma, usually higher grade)
- NF2 gene mutation in multiple meningioma or neurofibromatosis type 2 association
- Female sex and hormonal factors (estrogen and progesterone receptor expression on tumor)
- Age over 50 as predominant demographic risk factor
Treatment Options
Conservative
- MRI surveillance every 6–12 months for incidentally discovered, asymptomatic meningiomas in elderly or high-surgical-risk patients
- Corticosteroids (dexamethasone) for perioperative cord edema management
- Rehabilitation for neurological deficits while awaiting surgery or in post-operative recovery
Surgical
- Posterior laminectomy with microsurgical gross total resection — standard treatment achieving cure in most cases
- Duraplasty if the dural attachment cannot be safely resected (accepted alternative to leave involved dura and coagulate)
- Stereotactic radiosurgery (SRS) for recurrent or residual meningioma in patients not amenable to re-operation
When to see a spine specialist
Progressive leg weakness, sensory changes, or gait instability in a woman over 50 — even without significant back pain — should prompt MRI of the spine with gadolinium contrast. Spinal meningiomas are often diagnosed late due to their slow progression; earlier diagnosis and surgical intervention before significant cord signal change occurs substantially improves functional outcomes.
Specialists Who Treat Spinal Meningioma
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Search spine specialists →Frequently Asked Questions
Is spinal meningioma cancer?
The vast majority of spinal meningiomas are WHO Grade 1 (benign) tumors with excellent prognosis after surgical removal. Atypical (Grade 2) and anaplastic (Grade 3) meningiomas are rare in the spine and carry higher recurrence risk but remain classified as tumors of intermediate or high grade rather than true malignancies. Grade 1 meningiomas have recurrence rates under 5% at 10 years after gross total resection.
How complete is neurological recovery after surgery?
Neurological recovery after spinal meningioma resection is generally excellent, particularly for patients without pre-operative T2 signal change (myelomalacia) on MRI. Studies report functional improvement in 70–90% of patients after gross total resection. The most important predictors of recovery are shorter duration of symptoms and absence of intrinsic cord signal change. Patients who have had years of untreated cord compression with T2 signal change may stabilize but recover incompletely.
Can spinal meningioma recur after surgery?
Recurrence after gross total resection is uncommon, occurring in less than 5% of Grade 1 meningiomas at 10-year follow-up. Higher-grade tumors and cases where dural attachment was coagulated rather than excised carry higher recurrence rates (10–20%). MRI surveillance at 1 year and every 2–3 years thereafter is standard after resection. Recurrent meningiomas can be managed with re-operation or radiosurgery depending on size, location, and patient condition.