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Tumours
Intradural Extramedullary Tumours
An in-depth, evidence-based guide to intradural extramedullary spinal tumours — growths inside the spinal covering but outside the cord itself — and how they are recognised, imaged and referred for specialist care.
An intradural extramedullary tumour is a growth that sits inside the dura — the tough covering around the spinal cord — but outside the substance of the cord itself. In other words, it lies alongside the cord and the nerve roots rather than within them. Most tumours in this location are benign, the two commonest being schwannomas, which arise from nerve sheaths, and meningiomas, which arise from the covering of the cord. They tend to grow slowly and to cause symptoms by gradually pressing on the cord or the nerves. I want to be clear about my role from the outset: I do not personally operate on primary spinal tumours. My job is to recognise the problem, arrange the right imaging, and refer you promptly to a trusted colleague who specialises in this surgery and performs it in high volume.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
My role — recognising and referring, not operating
I think it is important to be straightforward about this. I am a spinal surgeon, but primary tumours of the spinal cord and its coverings are a distinct and highly specialised field, and I do not take them on myself. I firmly believe that this kind of surgery is best done by surgeons who do a high volume of it, because their experience translates directly into safer surgery and better outcomes. So if a tumour like this is found, my role is to identify it quickly, make sure the right scans are done, and refer you without delay to a colleague who is an expert in spinal tumour surgery. Everything below is written to help you understand the condition while that referral is arranged.
What these tumours are and how they cause symptoms
Because intradural extramedullary tumours sit next to the cord and nerve roots, they cause symptoms by compression as they enlarge. This often develops slowly. Common features include back or neck pain, sometimes worse at night, pain radiating along a nerve, numbness or altered sensation, weakness, and difficulties with balance and walking; when lower nerves are involved, bladder or bowel symptoms can occur. Schwannomas, arising from a nerve sheath, often produce nerve-root pain, while meningiomas, more common in the thoracic spine and in women, tend to present with gradual cord compression. Because the symptoms come on gradually, they are sometimes attributed to more common problems at first, which is why careful assessment matters.
How they are diagnosed
The key investigation is an MRI scan with contrast, which shows the tumour, its exact position relative to the cord and nerves, and features that help suggest its likely type. This imaging is essential both for diagnosis and for the specialist surgeon to plan treatment. My part is to ensure this imaging is arranged promptly and interpreted correctly, so that you reach the right specialist with the right information.
How they are treated — by a specialist colleague
The mainstay of treatment for a symptomatic or enlarging intradural extramedullary tumour is careful microsurgical removal, carried out by a spinal tumour specialist using an operating microscope and, where appropriate, nerve monitoring to protect function. Because most of these tumours are benign and well-defined, complete removal often gives an excellent and durable result, and the published evidence shows good neurological outcomes and low recurrence when surgery is performed by experienced hands. Some small, symptomless tumours can simply be monitored. The essential point is that where surgery is needed, it should be done by a high-volume specialist — which is exactly why I refer these cases on.
The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Every patient is different, and treatment options, risks, expected recovery and outcomes depend upon an individual's diagnosis, general health and personal circumstances. Decisions regarding treatment should always be made following consultation with your treating spinal surgeon or healthcare professional.
Evidence & further reading
- —Koeller KK, et al. Intradural extramedullary spinal neoplasms: radiologic-pathologic correlation. Radiographics 2019. (PMID 30844353)
- —Abul-Kasim K, et al. Intradural spinal tumours: current classification and MRI features. Neuroradiology 2008. (PMID 18084751)
- —Gu R, et al. MRI diagnosis of intradural extramedullary tumours. J Cancer Res Ther 2014. (PMID 25579530)
- —Arnautovic K, et al. Extramedullary intradural spinal tumours: modern diagnosis and treatment. Bosn J Basic Med Sci 2009. (PMID 19912118)
- —Patel P, et al. Clinical outcome of intradural extramedullary spinal cord tumours. Surg Neurol Int 2021. (PMID 33948315)
- —Randhawa AS, et al. Functional outcomes in intradural extramedullary spinal tumours. Surg Neurol Int 2024. (PMID 38742010)
- —Ng Z, et al. Intradural spinal tumours — postoperative outcomes: intramedullary vs extramedullary. World Neurosurg 2018. (PMID 28974413)
- —Narayan S, et al. Clinicopathological study of intradural extramedullary spinal tumours and functional outcome. Cureus 2021. (PMID 34285844)
- —Albanese V, et al. Spinal intradural extramedullary tumours: personal experience. J Neurosurg Sci 2002. (PMID 12118219)
- —Setzer M, et al. Management of spinal meningiomas: surgical results and review. Neurosurg Focus 2007. (PMID 17961038)
- —Alvarez-Crespo DJ, et al. Surgical outcomes of 2542 patients with spinal schwannomas: systematic review and meta-analysis. World Neurosurg 2024. (PMID 38006933)
- —Pinter NK, et al. Neuroimaging of spine tumours. Handb Clin Neurol 2016. (PMID 27430436)
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Every patient is different. The information on this page is a starting point — Mr Madi will tailor any plan to your specific imaging, symptoms and goals.