Clinical Features of Cauda Equina Tumors Requiring Surgical Treatment

Abstract

In this study, we evaluated the clinical features of cauda equina tumors requiring surgical treatment. Medical records of 28 patients with cauda equina tumors (13 men and 15 women) undergoing surgical treatment were retrospectively reviewed. The majority of histological diagnoses indicated schwannoma (23 cases, 82%), and the remaining 5 indicated ependymoma, neurofibroma, meningioma, and ganglioneuroblastoma. In 86% of the cases, the initial symptom was pain in the lower back and/or lower extremities. Preoperatively, half of the patients had symmetrical pain in the lower back or lower extremities, severe pain in the supine position, or pain that was increased by coughing. One third of the patients needed morphine to control nocturnal pain. Tumor size, as determined by magnetic resonance imaging (MRI), correlated with preoperative symptom duration (r = 0.66, p < 0.001). These findings indicate that symmetrical lower back pain and/or pain that radiates to both lower extremities and increases in the supine position are characteristic of cauda equina tumors. The correlation between symptom duration and tumor size indicates that earlier diagnosis of this tumor is necessary. Earlier diagnosis based on these characteristic symptoms should make use of further examinations such as MRI.cauda equina tumors; clinical features; surgical treatment

Giant schwannoma of the cauda equina without neurological deficits – case report and review of the literature

“…If located there, they may reach a remarkable size before they cause any neurological defi cit. Th eir slow growth in conjunction with the wide space of the lumbar spinal canal and the absence of the spinal cord in this region explains why the diagnosis of these lesions is often delayed and why most patients are admitted with a long history before the fi nal diagnosis is made [1,14,[20][21][22][23][24][25]. Clinical symptoms include a history of long-lasting back pain, sometimes radicular pain which is hard to diff erentiate from the pain caused by degenerative spinal diseases such as degenerative spinal canal stenosis.…”

“…Clinical symptoms include a history of long-lasting back pain, sometimes radicular pain which is hard to diff erentiate from the pain caused by degenerative spinal diseases such as degenerative spinal canal stenosis. Shimada et al [21] stated that lower back pain, sometimes symmetrically radiating into the legs which is increased in the supine position may be suggestive for such tumours whereas Conti and co-workers noticed segmental pain as the most frequent symptom in their 179 cases of spinal schwannomas [24]. In later stages of compression, patients usually develop neurological defi cits such as radicular motor weakness and fi nally bladder disturbance.…”

A long-segment string of bead-like schwannoma of cauda equina: a case report

“…First of all we emphasize the importance of the correlation of clinical features and symptoms of the patients. Symmetrical lower back pain and/ or pain that radiates to both lower extremities and increases in the supine position are characteristics of spinal tumors of cauda equina (2,3,13). Other clinical features of spinal tumors of cauda equina include progressive neurological defi cit, involvement of several nerve root levels and intractability of the condition to conservative therapy.…”

Why does delay exist in the diagnosis of intradural spinal cord tumor despite the availability of MRI?

“…Shimada et al reported that tumor size, as determined by MRI, correlated well with preoperative symptom duration. 25 Therefore, early diagnosis of spinal cord tumors is important in avoiding irreversible neurological deficits due to chronic compression of the spinal cord or cauda equina by tumors and the extensive surgical insult associated with their removal. In these cases, surgery is often required from both anterior and posterior approaches, leading in many cases to instability of the spine and the need for subsequent reconstructive surgical procedures.…”