Spinal neurofibromas are benign peripheral nerve sheath tumours, usually of the localized subtype.
This article specifically relates to spinal neurofibromas. For a general discussion of neurofibromas, including their epidemiology and pathology, refer to neurofibroma. For a discussion of the general radiographic features of neurofibromas, refer to spinal nerve sheath tumours.
Spinal neurofibromas are often asymptomatic 1. If symptoms are present, they usually include pain and/or radicular sensory changes due to the typical location along the dorsal sensory roots. Weakness is less common. As multiple lesions are common, patients may present with multiple radiculopathies. Myelopathy may occur if the lesion is large.
When located along spinal nerve roots, they are most frequently encountered along the cervical cord. They are difficult/impossible to categorically distinguish from schwannomas.
As they are slow growing they remodel the adjacent bone, often resulting in widening of the neural exit foramen with thinning of the pedicle and posterior vertebral body scalloping.
- well-defined hypodense mass
- frequently causing widening of the neural foramen with extraspinal extension: dumbbell shape 5
- however this shape is not specific and can be seen with schwannomas and meningiomas 5
- minimal or no contrast enhancement
- T1: hypointense
- a hyperintense rim and central area of low signal (“target sign”) may be seen; this is thought to be due to a dense central area of collagenous stroma.
- although this sign is highly suggestive of neurofibroma, it is occasionally also seen in schwannomas and malignant peripheral nerve sheath tumours
- T1 C+ (Gd): heterogenous enhancement
Refer to spinal nerve sheath tumours for further discussion of radiographic appearances.
Treatment and prognosis
Neurofibromas are slow growing. Surgery is the treatment of choice for symptomatic lesions. However, as neurofibromas tend to encase the nerve roots, they usually cannot be dissected from the parent nerve 4. 5-10% of neurofibromas undergo malignant change 3, which may be indicated by rapid growth.
The main differential for spinal neurofibromas includes:
For a more comprehensive discussion of the differential diagnosis please refer to the genertic article on spinal nerve sheath tumours.
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- 2. Brant WE, Helms CA. Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins. (2007) ISBN:0781761352. Read it at Google Books - Find it at Amazon
- 3. Weissleder R, Wittenberg J, M.D. MG et-al. Primer of Diagnostic Imaging, Expert Consult- Online and Print. Mosby. (2011) ISBN:0323065384. Read it at Google Books - Find it at Amazon
- 4. Osborn AG. Diagnostic neuroradiology. Mosby Inc. (1994) ISBN:0801674867. Read it at Google Books - Find it at Amazon
- 5. Kumar SA, Kumar M, Malgonde M. Dumbbell-shaped neurofibroma of the upper thoracic spine: A case report. South Asian J Cancer. 2013;2 (4): 226. doi:10.4103/2278-330X.119925 - Free text at pubmed - Pubmed citation