Intradural extramedullary spinal cord tumors


Authors: P. Moják 1;  M. Filip 2,3;  P. Linzer 1;  P. Jurek 1;  M. Mitaľ 1;  A. Švehlák 1;  K. Trenzová 1
Authors‘ workplace: Neurochirurgické oddělení, Krajská nemocnice T. Bati, a. s., Zlín 1;  Ústav rehabilitace, LF OU, Ostrava 2;  Neurochirugická klinika LF UK, SZU a UN Bratislava 3
Published in: Cesk Slov Neurol N 2019; 82(2): 0
Category: Minimonography
doi: 10.14735/amcsnn2019125

Overview

Intradural extramedullary spinal cord tumors represent a relatively small group among all of the tumors of the CNS. This article describes the most frequent types of these tumors, their etiology, macroscopic and histologic characteristics, clinical symptoms, diagnosis and treatment. It describes the clinical outcome of several surgery techniques and their effect on the stability of the spine, the radicality of the resection and the consequent neurological condition of the patient. It analyses the importance of pre-operative preparation, planning, the position of the patient during surgery, perioperative medicamentous treatment and the use of instrumentation opportunities. It evaluates its impact on postoperative outcome, the eventual complications and the overall prognosis of the patient. These aspects are particularly pre-evaluated in the most frequent types of intradural extramedullary spinal cord tumors which are nerve sheath tumors and meningeoms. There is also a brief description devoted to less frequent tumors in this article. There are simple and concise recommendations on the diagnostics and therapy of these tumors in the discussion part and the closure, and these recommendations are aimed at the improvement of the treatment effect and minimizing the risk of complications in accordance with available studies.

The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Keywords:

intradural extramedullary spinal cord tumor – schwannoma – meningeoma – diagnosis – surgical treatment – surgical outcomes


Sources

1. Rychlý B. Histopatológia nádorov chrbtice a miechy. Neurol praxi 2009; 10(4): 213–215.
2. Kalina P. Klinické prejavy nádorov chrbtice a miechy. Neurol praxi 2009; 10(4): 209–212.
3. Náhlovský J (eds). Neurochirurgie. Praha: Galén 2006.
4. Gebauer GP, Farjoodi P, Sciubba DM et al. Magnetic resonance imaging of spine tumors: classification, differential diagnosis, and spectrum of disease. J Bone Joint Surg Am 2008; 90(Suppl 4): 146–162. doi: 10.2106/JBJS.H.00825.
5. Arnautovic K, Arnautovic A. Extramedullary intradural spinal tumors: a review of modern diagnostic and treatment options and a report of a series. Bosn J Basic Med Sci 2009; 9(Suppl 1): S40–S45. doi: 10.17305/bjbms.2009.2755.
6. Šteňo J, Illéš R. Súčasné princípy chirurgického liečenia nádorov chrbtice a miechy. Neurol praxi 2009; 10(4): 224–227.
7. Thamburay VA. Spinal cord tumors: textbook of contemporary neurosurgery. New Delhi: Jaypee Brothers Medical Publishers 2012.
8. Murphey MD, Smith WS, Smith SE et al. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiographics 1999; 19(5): 1253–1280. doi: 10.1148/radiographics.19.5.g99se101253.
9. Ross JS, Brant-Zawadzki M, Moore KR et al. Diagnostic imaging: spine. 1st ed. Salt Lake City: Amirsys 2004.
10. Hufana V, Tan JS, Tan KK. Microsurgical treatment for spinal tumors. Singapore Med J 2005; 46(2): 74–77.
11. Albanese V, Platania N. Spinal intradural extramedullary tumors. Personal experience. J Neurosurg Sci 2002; 46(1): 18–24.
12. Helseth A, Mork SJ. Primary intraspinal neoplasms in Norway 1955 to 1986. A population-based survey of 467 patients. J Neurosurg 1989; 71(6): 842–845.
13. Stawicki SP, Guarnaschelli JJ. Intradural extramedullary spinal cord tumors: a retrospective study of tumor types, locations, and surgical outcomes. [online]. Int J Neurosurg 2007; 4(2). Available from URL: https://print.ispub.com/api/0/ispub-article/5818.
14. Mahalingam SS. Victor Horsley and spinal surgery. J Spinal Surg 2016; 3(2): 68–69.
15. Tan TC, Black PM. Sir Victor Horsley (1857–1916): pioneer of neurological surgery. Neurosurgery 2002; 50(3): 607–612.
16. Griessenauer CJ, Tubbs RS, Shoja MM et al. Alfred W. Adson (1887–1951): his contributions to surgery for tumors of the spine and spinal cord in the context of spinal tumor surgery in the late 19th and early 20th centuries. J Neurosurg Spine 2013; 19(6): 750–758. doi: 10.3171/2013.9.SPINE13220.
17. Jagadesh BK, Reddy S, Ponraj S et al. clinicopathological study of intradural extramedullary spinal cord tumors. In Sch J Med Case Rep 2014; 2(2): 108–111.
18. Van Goethem JW, van den Hauwe L, Özsarlak Ö. Spinal tumors. Eur J Radiol 2004; 50(2): 159–176. doi: 10.1016/j.ejrad.2003.10.021.
19. Bhatt M, Lieberman G. Spinal tumors. [online]. Lieberman´s eRadiology Learning Sites 2009. Available from URL: http://eradiology.bidmc.harvard.edu/LearningLab/central/Bhatt.pdf.
20. Iacob G. Spinal meningiomas. Personal experience and review of literature. Romanian Neurosurg 2014; 21(2): 147–161. doi: https://doi.org/10.2478/romneu-2014-0016.
21. Govind M, Radheyshyam M, Achal S et al. Intradural extramedullary spinal cord tumors. Romanian Neurosurgery 2016; 30(1): 106–112. doi: 10.1515/romneu-2016-0017.
22. Goldbrunner R. Intradural extramedullary tumors. In: Tonn JC, Westphal M, Rutka JT. Oncology of CNS tumors. Berlin, Heidelberg: Springer 2010: 709–718.
23. Song KW, Shin SI, Lee JY et al. Surgical results of intradural extramedullary tumors. Clin Orthop Surg 2009; 1(2): 74–80. doi: 10.4055/cios.2009.1.2.74.
24. Ahn DK, Park HS, Choi DJ et al. Surgery for spinal intradural extramedullary tumors. Clinics Orthop Sur 2009; 1(3): 165–172. doi: 10.4055/cios.2009.1.3.165.
25. Shin BJ, Lee JC, Yoon TK et al. Surgical treatments of intradural extramedullary tumor. J Korean Soc Spine Surg 2002; 9(3): 230–237.
26. Jung KW, Park KH, Ha J et al. Primary spinal cord tumors in Korea. Cancer Res Treat 2015; 47(2): 166–172. doi: 10.4143/crt.2014.017.
27. Bhat AR, Kirmani AR, Wani MA et al. Incidence, histopathology, and surgical outcome of tumors of spinal cord, nerve roots, meninges, and vertebral column – data based on single institutional (Sher-i-KashmirInstitute of Medical Sciences) experience. J Neurosci Rural Pract 2016; 7(3): 381–391. doi: 10.4103/0976-3147.181489.
28. Kim SB, Kim AS, Jang JS et al. Mobility of Schwannoma at spine. J Korean Neurosurg Soc 2010; 47(1): 64–67. doi: 10.3340/jkns.2010.47.1.64.
29. Rudinský B. Manažment liečby pacientov s nádormi chrbtice s pohľadu spinálneho chirurga. Onkológia (Bratislava) 2008; 3(4): 253–256.
30. McCulloch JA, Young PH. Essentials of Spinal Microsurgery. 7th ed. Philadelphia: LWW 1998: 668.
31. Menezes AH, Sonntag VK (eds). Principles of spinal surgery. New York: McGraw-Hill Healthcare 1996: 817.
32. Vaccaro AR, Betz RR, Zeidman SM. Principles and practice of spine surgery. 1st ed. Phliladelphia: Mosby 2002: 888.
33. Němec M. Peroperační neurofyziologické monitorování míchy. Neurol pro praxi 2008; 9(2): 79–82.
34. Sim JE, Noh SJ, Song YJ et al. Removal of intradural-extramedullary spinal cord tumors with unilateral limited laminectomy. J Korean Neurosur Soc 2008; 43(5): 232–236. doi: 10.3340/jkns.2008.43.5.232.
35. Tandra N, Tamrakar BB, Dapeng L et al. Removal of intradural-extramedullary spinal cord tumors with unilateral limited laminectomy. J Dent Med Sci 2018; 13(6): 62–64.
36. Chiou SM, Eggert HR, Laborde G et al. Microsurgical unilateral approaches for spinal tumour surgery: eight years' experience in 256 primary operated patients. Acta Neurochir (Wien) 1989; 100(3–4): 127–133.
37. Eggert HR, Scheremet R, Seeger W et al. Unilateral microsurgical approaches to extramedullary spinal tumours. Operative technique and results. Acta Neurochir (Wien) 1983; 67(3–4): 245–253.
38. Bertalanffy H, Mitani S, Otani M et al. Usefullness of hemilaminectomy for microsurgical management of intraspinal lesions. Keio J Med 1992; 41(2): 76–79.
39. Tredway TL, Santiago P, Hrubes MR et al. Minimally invasive resection of intradural-extradullary spinal neoplasms. Neurosurgery 2006; 58(Suppl 1): 52–58.
40. Jurek P, Linzer P, Filip M. Intraoperative sonography in spinal tumor surgery. Prezentováno na: XXIII. postgraduálním kurzu v neurochirurgii 2016, Hradec Králové, Česká republika.
41. Šulla I, Šanta M, Fagula J. Twodimensional ultrasonoghraphy during spinal surgery. Zentbl Neurochir 1990; 51(3): 160–163. 
42. Jeon JH, Hwang HS, Jeong JH et al. Spinal schwannoma: analysis of 40 cases. J Korean Neurosurg Soc 2008; 43(3): 135–138. 
43. Wu D, Ba Z, Huang Y et al. Totally cystic schwannoma of the lumbar spine. Orthopedics 2013; 36(5): e679–e682. doi: 10.3928/01477447-20130426-36.
44. Yeh HM, Leung JH, Huang KC et al. Atypical hemorrhagic spinal schwannoma. J Radiol Sci 2011; 36(9): 191–194.
45. Osborn AG. Intradural extramedullary tumors, cysts, and tumor like masses. In: Diagnostic Neuroradiology. 2nd ed. St Louis: Mosby 1994: 895–906.
46. Hsieh CT, Tsai WC, Liu MY. Intradural lumbar cystic schwannoma. Neurosciences (Riyadh) 2011;16(4): 366–368.
47. Yamahata H, Yamaguchi S, Mori M et al. Ventral schwannoma of the thoracolumbar spine. Asian Spine J 2013; 7(4): 339–344. doi: 10.4184/asj.2013.7.4.339.
48. Ueda R, Yoshida K, Kawase T. Intradural C-1 ventral root schwannomas treated by surgical resection via the lateral suboccipital transcondylar approach: three case reports. Neurol Med Chir (Tokyo) 2006; 46(6): 298–301.
49. Mahore A, Chagla A, Goel A. Giant ventral midline schwannoma of cervical spine: agonies and nuances. J Korean Neurosurg Soc 2010; 47(6): 454–457. doi: 10.3340/jkns.2010.47.6.454.
50. Kanemoto Y, Ohnishi H, Koshimae N et al. Ventral T-1 neurinoma removed via hemilaminectomy without costotransversectomy: case report. Neurol Med Chir (Tokyo) 1999; 39(9): 685–688.
51. Turgut M, Erkus M. Giant schwannoma of the cauda equina: case report and review of the literature. Zentralbl Neurochir 2008; 69(2): 99–101. doi: 10.1055/s-2008-1073124.
52. Karagoz Guzey F, Bas NS, Emel E et al. Planning of surgical management of giant spinal schwannomas: report of four cases. Turkish Neurosurg 2006; 16(3): 139–144.
53. Stepanov S, Kozic D, Prvulovic N. An unusual MR finding of spinal schwannoma. Arch Oncol 2008; 17(3): 86–87. doi: 10.2298/AOO0904086S.
54. Parmar H, Patkar D, Gadani S et al. Cystic lumbar nerve sheath tumours: MRI features in five patients. Australas Radiol 2001; 45(2): 123–127.
55. Santhosh K, Kesavadas C, Thomas B et al. Fluid-fluid levels in cystic lumbosacral schwannomas: a report of three cases. Singapore Med J 2009; 50(1): 16–21.
56. Shiono T, Yoshikawa K, Iwasaki N. Huge lumbar spinal cystic neurinomas with unusual MR findings. AJNR Am J Neuroradiol 1995; 16(Suppl 4): 881–882.
57. Thamburaj K, Radhakrishnan VV, Thomas B et al. Intratumoral microhemorrhages on T2- weighted gradient-echo imaging helps differentiate vestibular schwannoma from meningioma. AJNR Am J Neuroradiol 2008; 29(3): 552–557. doi: 10.3174/ajnr.A0887.
58. Celli P, Cervoni L, Tarantino R et al. Primary spinal malignant schwannomas: clinical and prognostic remarks. Acta Neurochir (Wien) 1995; 135(1): 52–55.
59. Safaee M, Parsa AT, Barbaro NM et al. Association of tumor location, extent of resection, andneurofibromatosis status with clinical outcomes for 221 spinal nerve sheath tumors. Neurosurg Focus 2015; 39(2): 1–8.
60. Antinheimo J, Sankila R, Carpén O et al. Population based analysis of sporadic and type 2 neurofibromatosis associated meningiomas and schwannomas. Neurology 2000; 54(1): 71–76. 
61. Levy WJ Jr, Bay J, Dohn D. Spinal cord meningioma. J Neurosurg 1982; 57(6): 804–812. doi: 10.3171/jns.1982.57.6.0804.
62. Solero CL, Fornari M, Giombini S et al. Spinal meningiomas: review of 174 operated cases. Neurosurgery 1989; 25(2): 153–160.
63. Keskin F, Kalkan E, Karatas Y et al. A case of upper thoracic spinal multiple meningiomas. Neurosurg Q 2013; 23(3): 224–225.
64. Yoshiura T, Shriee DA, Pilcher WH et al. Cervical spinal meningioma with unusual MR contrast enhancement. AJNR Am J Neuroradiol 1998; 19(6): 1040–1042.
65. Deen HG Jr, Scheithauer BW, Ebersold MJ. Clinical and pathological study of meningiomas of the first two decades of life. J Neurosurg 1982; 56(3): 317–322. doi: 10.3171/jns.1982.56.3.0317.
66. Glasier CM, Husain MM, Chadduck W et al. Meningioma in children: MR and histopathological findings. AJNR Am J Neuroradiol 1993; 14(1): 237–241.
67. Mawrin C, Perry A. Pathological classification and molecular genetics of meningiomas. J Neurooncol 2010; 99(3): 379–391. doi: 10.1007/s11060-010-0342-2.
68. Mclendon RE, Rosenblum MK, Bigner DD. Russell and Rubinstein’s pathology of tumors of the nervous system. Boca Raton: CRC Press 2006: 1104.
69. Roux FX, Nataf F, Pinaudeau M et al. Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol 1996; 46(5): 458–463.
70. Preston-Martin S, Monroe K, Lee PJ et al. Spinal meningiomas in women in Los Angeles County: investigation of an etiological hypothesis. Cancer Epidemiol Biomarkers Prev 1995; 4(4): 333–339.
71. Lee JH. Meningiomas: diagnosis, treatment, and outcome. London: Springer-Verlag 2009: 639.
72. Hafiz MG, Rahman MR, Yeamin MB. Intradural intramedullary spinal cord meningioma in a seven years old female child. Mymensingh Med J 2013; 22(1): 180–185.
73. Moriuchi S, Nakagawa H, Yamada M et al. Intramedullary spinal cord meningioma: a case report. Neurol Med Chir (Tokyo) 1996; 36(12): 888–892.
74. Sahni D, Harrop JS, Kalfas IH et al. Exophytic intramedullary meningioma of the cervical spinal cord. J Clin Neurosci 2008; 15(10): 1176–1179. doi: 10.1016/j.jocn.2007.08.025.
75. Yuan D, Liu D, Yuan XR et al. Intramedullary thoracic spinal cord meningioma: a rare case report and review of the literature. J Neurol Surg A Cent Eur Neurosurg 2013; 74(Suppl 1): 136–139. doi: 10.1055/s-0032-1330959.
76. Teo M, Zrinzo L, King A et al. Giant extradural sacral meningioma. Acta Neurochir (Wien) 2010; 152(3): 485–488. doi: 10.1007/s00701-009-0414-2.
77. Galgano MA, Beutler T, Brooking A et al. Spinal meningiomas: a review. J Spine 2014; 3(1): 157.
78. Gezen F, Kahraman S, Canakci Z et al. Review of 36 cases of spinal cord meningioma. Spine (Phila Pa 1976) 2000; 25(6): 727–731.
79. Ciurea AV, Tascu A, Palade CL et al, Microsurgical approach in a thoracic meningioma. Case report. Romanian Neurosurg 2010; XVII(1): 81–87.
80. Matsumoto S, Hasuo K, Uchino A et al. MRI of intraduralextramedullary spinal neurinomas and meningiomas. Clin Imaging 1993; 17(1): 46–52.
81. Brown MH. Intraspinal meningioma: a clinical and pathologic study. Arch Neur Psych 1942; 47(2): 271–292. doi:10.1001/archneurpsyc.1942.02290020087008.
82. Klekamp J, Samii M. Surgical results for spinal meningiomas. Surg Neurol 1999; 52(6): 552–562.
83. Gamache FW Jr, Wang JC, Deck M et al. Unusual appearance of an en plaque meningioma of the cervical spinal canal. A case report and literature review. Spine (Phila Pa 1976) 2001; 26(5): E87–E89.
84. Salpietro FM, Alafaci C, Lucerna S et al. Do spinal meningiomas penetrate the pial layer? Correlation between magnetic resonance imaging and microsurgical findings and intracranial tumor interfaces. Neurosurgery 1997; 41(1): 254–257.
85. Kernohan JW. Primary tumors of the spinal cord and intradural filum terminale. Penfield W. Cytology and cellular pathology of the nervous system. New York: Paul B.Hoeber 1932: 993–1035. 
86. Quiles AM, Roselló EG, Laguillo G et al. A Comprehensive review of intraspinal tumors: diagnostic, classification and radio-pathologic correlation. [online]. Available form URL: http://pdf.posterng.netkey.at/download/index.php?module=get_pdf_by_id&poster_id=11702.
87. Wager M, Lapierre F, Blanc JL et al. Cauda equina tumors: a French multicenter retrospective review of 231 adult cases and review of the literature. Neurosurg Rev 2000; 23(3): 119–129. 
88. Meneses MS, Leal AG, Periotto LB et al. Primary filum terminale ependymoma: a series of 16 cases. Arq Neuropsiquiatr 2008; 66(3A): 529–533.
89. Fearnside MR, Adams CB. Tumors of the cauda equina. J Neurol Neurosurg Psychiatry 1987; 41(1): 24–31. 
90. Shimada Y, Miyakoshi N, Kasukawa Y et al. Clinical features of cauda equina tumors requiring surgical treatment. Tohoku J Exp Med 2006; 209(1): 1–6
91. Kumar V, Solanski RS. Myxopapillary ependymoma of the filum terminale. Pediatr Radiol 2009; 39(4): 415. doi: 10.1007/s00247-008-1100-x.
92. Wippold FJ, Smirniotopoulos JG, Morgan CJ et al. MR imaging of myxopapillary ependymoma: findings and value to determine extent of tumour and its relation to intraspinal structures. AJR Am J Roentgenol 1995; 165(5): 1263–1267. doi: 10.2214/ajr.165.5.7572515.
93. Carragher AM, Heatley MK, Mirakhur M et al. A clinicopathological review of spinal ependymomas in Northern Ireland. Ulster Med J 1990; 59(1): 51–54.
94. Rewcastle NB, Berry K. Neoplasms of the lower spinal canal. Neurology 1964; 14: 608–615.
95. Kim JS, Choi KC, Jung B et al. Myxopapillary ependymoma of filum terminale mimicking nerve sheath tumor. Kor J Spine 2008; 5(2): 95–98.
96. McCormick PC, Torres R, Post KD et al. Intramedullary ependymoma of the spinal cord. J Neurosurg 1990; 72(4): 523–532. doi: 10.3171/jns.1990.72.4.0523.
97. Do-Dai DD, Rovira MJ, Ho VB et al. Childhood onset of myxopapillary ependymomatosis: MR features. AJNR Am J Neuroradiolog 1995; 16(Suppl 4): 835–839. 
98. Sonneland PR, Scheithauer BW, Onofrio BM. Myxopapillary ependymoma: a clinicopathologic and immunocytochemical study of 77 cases. Cancer 1985; 56(4): 883–893.
99. Macedo LT, Rogerio F, Pereira E.B et al. Cerebrospinal tumor dissemination in a patient with myxopapillary ependymoma. J Clin Oncol 2011; 29(32): e795–e798. doi: 10.1200/JCO.2011.36.6625.
100. Wiestler OD, Schiffer D, Coon SW et al. Myxopapillary ependymoma. In: Kleihues P, Cavenee WK (eds). Pathology and Genetics Tumors of the Nervous System. Lyon: IARC Press 2000: 78–79. 
101. Yoshii S, Shimizu K, Ido K et al. Ependymoma of the spinal cord and the cauda equina region. J Spinal Disord 1999; 12(2): 157–161.
102. Lin YH, Huang CI, Wong TT et al. Treatment of spinal cord ependymomas by surgery with or without postoperative radiotherapy. J Neurooncol 2005; 71(2): 205–210. doi: 10.1007/s11060-004-1386-y.
103. Sato H, Ohmura K, Mizushima M et al. Myxopapillary ependymoma of the lateral ventricle: a study on the mechanism of its stromal myxoid change. Acta Pathol Jpn 1983; 33(5): 1017–1025.
104. Rawlinson DG, Herman MM, Rubinstein LJ. The fine structure of a myxopapillary ependymoma of the filum terminale. Acta Neuropathol 1973; 25(1): 1–13.
105. Landi A, Mancarella C, Marotta N et al. Diagnosis and treatment of paragangliomas of the filum terminale, an extremely rare entity: personal experience and literature review. J Spine 2013; S3(1): 1–4. doi:10.4172/2165-7939.S3-001.
106. Kohn A. Die paraganglien. Arch Mikrobiol 1903; 62: 263–265.
107. Kalani MA, Cchang SD, Vu B. Paraganglioma of the filum terminale: case report, pathology and review of the literature. Cureus 2015; 7(10): e354. doi: 10.7759/cureus.354.
108. Brock RS, Noleto G, Oliveira MF et al. Paraganglioma of the filum terminale – a case report. J Spine Neurosurg 2016; 5(2): 1–3.
109. Aggarwal S, Deck JH, Kucharczyk W. Neuroendocrine tumor (paraganglioma) of the cauda equina: MR and pathologic findings. AJNR Am J Neuroradiol 1993; 14(4): 1003–1007.
110. Ho WT, Tai KS. Magnetic resonance imaging evaluation of paraganglioma in the cauda equina. J HK Coll Radiol 2002; 5, 230–232.
111. Herman M, Pozzi-Mucelli RS, Skrap M. Paraganglioma of the cauda equina: case report and review of the MRI features. Acta Univ Palacki Olomouc Fac Med 1998; 141: 27–30.
112. Hong JY, Hur CY, Modi HN et al. Paraganglioma in the cauda equina. A case report. Acta Orthop Belg 2012; 78(3): 418–423.
113. Midi A, Yener AR, Sav A et al. Cauda equina paraganglioma. Turkish Neurosurg 2012; 22(3): 353–359. doi: 10.5137/1019-5149.JTN.3389-10.1.
114. Moran CA, Rush W, Mena H. Primary spinal paragangliomas: a clinicopathological and immunohistochemical study of 30 cases. Histopathology 1997; 31(2): 167–173.
115. Koeller KK, Rosenblum RS, Morrison AL. Neoplasms of the spinal cord and filum terminale: radiologic-pathologic correlation. Radiographics 2000; 20(6): 1721–1749. doi: 10.1148/radiographics.20.6.g00nv151721.
116. da Silva ME, Carvalho MJ, Rodrigues AP et al. Rare vertebral metastasis in a case of hereditary paraganglioma. Hered Cancer Clin Pract 2012; 10(1): 12. doi: 10.1186/1897-4287-10-12.
117. Ilgren EB, Teddy PJ. Chemodectoma of the cauda equina: case report. Clin Neuropathol 1984; 3(4): 148–152.
118. Russel CD, Jander HP, Dubovsky EV. Demonstration of a chemodectoma by perfusion scanning: case report. J Nucl Med 1975; 16(6): 472–473.
119. El-Mahdy W, Kane PJ, Powell MP et.al. Spinal intradural tumours: Part I. Extramedullary. Br J Neurosurg 1999; 13(6): 550–557.
120. Asazuma T, Toyama Y, Watanabe M et al. Clinical features associated with recurrence of tumours of the spinal cord and cauda equina. Spinal Cord 2003; 41(2): 85–89. doi: 10.1038/sj.sc.3101394.
121. Wikipedia. Sir Victor Alexander Haden Horsley. [online]. Available form URL: https://en.wikipedia.org/wiki/Victor_Horsley.
122. Ball JR. Intradural spinal cord tumours. [online]. Available from URL: http://spinesurgeon.sydney/services/spinal-tumours/intradural-spinal-cord-tumours/.
123. Wein S. Spinal neurofibroma. [online]. Available from URL:https://radiopaedia.org.

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