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Neurinoma, neurilemmoma (outdated terms)
Neoplasm of nerve sheath (Schwann cells)
70-75% intradural extramedullary
Most common intradural extramedullary mass
15% completely extradural
15% transforaminal, “dumbbell” masses
Size varies from small intradural mass to large intraspinal or paravertebral mass (“giant schwannoma”) extending ≥ 2 vertebral segments
Bone remodeling due to large intraspinal or intraforaminal tumor common
Cystic change common
Calcifications, hemorrhage are rare
Uniform, heterogeneous, or peripheral enhancement patterns
Neurofibroma
Perineural root sleeve cyst
Myxopapillary ependymoma
Meningioma
Leptomeningeal carcinomatosis
Neuroblastic tumor
WHO grade I
Neurofibromatosis type 2 (NF2): Loss of tumor suppressor (merlin) on chromosome 22
Sporadic schwannoma more common than NF2
Inactivating mutations of merlin gene in ~ 60%
Pain, weakness, paresthesias most common clinical findings
Typically solitary unless part of inherited tumor syndrome
Schwannoma most likely when solitary enhancing “dumbbell-shaped” spinal lesion present
Neurofibromatosis type 2 (NF2)
Multiple inherited schwannomas, meningiomas, and ependymomas (MISME)
Neurinoma, neurilemmoma (outdated terms)
Nerve sheath tumor (NST)
Neoplasm of nerve sheath (Schwann cells)
Best diagnostic clue
Well-circumscribed, “dumbbell-shaped' transforaminal mass
Solitary or multiple enhancing cauda equina nodules
Location
70-75% intradural extramedullary
Most common intradural extramedullary mass
15% completely extradural
15% “dumbbell”
Both intra- and extradural
Rare intramedullary
Thoracic > cervical = lumbar
Size
Most are small: Few millimeters in diameter
Giant schwannoma
Extend ≥ 2 vertebral segments
Paraspinal extension > 2.5 cm
Posterolateral extension into myofascial planes: Giant invasive schwannoma
Lumbosacral spine most common
Morphology
Round
Lobulated
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