Meningiomas are the second most frequent intraspinal tumours. They are generally benign and slow-growing.The ratio of intraspinal to intracranial meningiomas is about 1:8. The peak incidence is in the fifth and sixth decades and the male to female ratio is 1:4. Ninety percent of spinal meningiomas are intradural, whereas five percent are extradural. The thoracic spine is the most common site followed by the cervical spine. Signs of spinal cord compression such as impaired motor, sensory and sphincter functions develop because of mass effect.
On CT meningiomas are seen as solid, smoothly marginated masses, isodense to skeletal muscle, which enhance markedly. In some cases intrathecal contrast may be required for diagnosis.
For radiological diagnosis MRI is the best choice. Meningioma appears isointense to gray matter on all sequences and enhances rapidly and intensely. Most spinal meningiomas have a broad-based dural attachement and a dural "tail" sign may be seen in some cases. Meningiomas may calcify and appear hyperdense on CT, hypointense in all sequences on MRI, with only minimal contrast enhancement.
Treatment is surgical removal of the mass. The goal of surgical treatment must be total resection, if possible. However, spinal meningiomas may recur, especially as a result of incomplete resection. If total removal of the tumour cannot be achieved, or in the case of early recurrence followed by total resection, radiotherapy should be performed as adjuvant therapy.
