0:01

This was a woman who was complaining about cervical

0:04

spine neck pain without radiculopathy.

0:07

As the study was being performed for cervical

0:10

spine degenerative changes,

0:12

it was noted that the neuroforamen

0:14

was enlarged at the C6-C7 level.

0:18

The axial scans in the soft tissue and in the bone

0:22

algorithm showed that there appeared to be a mass that

0:26

was present at that level that was slightly

0:30

hyperdense to the normal spinal cord,

0:34

and there was the enlargement of the neuroforamen

0:38

associated with it. Now, this combination of a mass in the

0:42

intradural extramedullary compartment with enlargement of the

0:45

neuroforamen, would probably lead to a

0:48

diagnosis of a nerve sheath tumor.

0:50

An MRI scan was requested for verification.

0:54

The study was done with contrast,

0:57

and I'm just going to show you the

0:58

post-gadolinium enhanced images.

1:01

So here we have the sagittal post-contrast scan, and you'll

1:04

notice that the mass is associated with dural tail

1:10

and it sort of sandwiches the spinal cord.

1:12

However, potentially we can still identify the enlargement of the

1:19

subarachnoid space when we look at the scan here more

1:23

inferiorly where the there is widening of the CSF space.

1:27

On the axial scan, we see that the mass is displacing

1:30

the spinal cord to the right side, is filling the thecal sac,

1:35

but also extends out into the soft tissues of the

1:39

cervical region, including the brachial plexus.

1:41

This ended up being a meningioma of the cervical spine

1:46

and the key feature was the dural

1:49

tail that was associated with it.

1:51

So just to make sure we're all on the same page,

1:53

this is the mass,

1:55

this is the portion of the dural tail

1:58

that's seen posteriorly.

2:00

And the more anterior part is what

2:03

we see on the axial scan,

2:05

where you can see it curves around to come anterior

2:09

to the spinal cord on the left side.

2:12

One curious thing is that the dural tail does not

2:16

necessarily mean that there are tumor cells at that

2:21

location. When you look histopathologically,

2:24

in some of the cases,

2:25

the dural tail represents reactive change in the

2:29

meninges with fibrovascular infiltration

2:32

without neoplastic spread. However,

2:36

that's only determined postoperatively in the

2:39

histopathologic evaluation. Therefore,

2:42

most surgeons will operate and try to take out the

2:45

entire dural tail with the meningioma, because they don't

2:50

know whether there's tumor cells within that tail.

2:53

And so to prevent recurrence or residual tumor,

2:56

they will resect the entire portion of the lesion including the tail.

3:02

Nonetheless, as you look at this particular scan,

3:05

you see that there is a difference between the tumor,

3:08

clearly the tumor portion and the brighter

3:11

signal intensity that is the dural tail.

3:14

In this particular case,

3:16

I would wonder whether that is fibrovascular

3:19

proliferation as opposed to neoplastic

3:21

infiltration of the dural tail.