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This was a woman who was operated previously for

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cervical spine pain and was being followed up for

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persistent pain. On the sagittal T1-weighted scan,

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we see the post-operative changes here at C2,

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C5, and C6, with anterior plate and screws

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for the fusion at C5 and C6.

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We see a little bit of an indentation by the

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disc at the C5-C6 level on the thecal sac.

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And you'll notice that the thecal sac is narrowed here because

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this is an extradural impression on the thecal sac.

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So narrowing as opposed to widening.

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When we scroll the patient scans,

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we notice that there is a mass which

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is seen here at the C2 level,

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which has a different characteristic

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feature from the disc,

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and that is that there's widening of this cerebrospinal

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fluid at the border with the lesion.

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And therefore this is an intradural extramedullary

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mass. It is displacing the spinal cord posteriorly.

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As we scroll,

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we see that the spinal cord is being displaced slightly

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and there is a tiny area of high signal intensity within

1:12

the spinal cord anteriorly from that compression.

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Let's look on the axial scans now.

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So scrolling through these images,

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we see that the lesion is to the left of midline,

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that it is closely associated with the neural foramen,

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but is within the thecal sac.

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And there is that indentation on the spinal cord,

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causing it to have this kind of semilunar appearance in

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a tiny area where there is bright signal intensity

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in the anterior portion of the spinal cord,

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although not dramatic.

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Post-gadolinium enhance scans were also performed

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in the sagittal and axial plane.

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Here we see that the lesion shows contrast enhancement

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quite avidly, and is associated with the anterior dura.

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I'm going to demonstrate that there is a small, little

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area of enhancement of the dura leading superior

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from the lesion, the so called dural tail.

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And on the axial scan,

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we see that this has that basis along the anterior

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border of the dura to the left of midline.

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I'm going to maximally magnify this,

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so that way that dural tail is going to be better seen.

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And I'll point that out once again, that this small

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trailing area of enhancement is what is referred

2:32

to as the dural tail of a meningioma.

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So even though this lesion is located

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in the cervical region,

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and you've heard me say numerous times that nerve sheath

2:42

tumors are much more common than meningiomas

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in the cervical region.

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And even though this is a patient who

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has a lesion anteriorly located.

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Whereas, more commonly, meningiomas are posteriorly

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located in the thecal sac. By virtue of

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that enhancing dural tail,

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I would describe this lesion as a

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C2 intradural extramedullary mass

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with features of a dural tail,

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making meningioma more likely than schwannoma.

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Really, there are no other tumors that we would suggest besides

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the nerve sheath tumors and the meningioma in this case.