Clininal Symptoms and Surgical Results of Cauda Equina Tumors

Abstract

Twenty-three cases of cauda equina tumor were studied for clinical symptoms, image findings, and surgical results. Pathological diagnosis was Schwannoma in eighteen patients, ependymoma in two, and one case of oligodendroglioma, malignant lymphoma, and lung cancer metastasis, respectively. Resection of the tumor by laminectomy or laminoplasty was performed in all cases except patients with malignant lymphoma and lung cancer metastasis. Partial resection was done in lung cancer metastasis and radiation was applied after open biopsy in malignant lymphoma.
Sixteen patients (70%) complained of low back pain and seventeen patients (74%) of leg pain. Neurological deficits such as motor weakness and difficulty in urination were seen in six cases. No specific clinical signs or symptoms which differentiated cauda equina tumor from other lumbar diseases were found.
MRI clearly showed a tumor; although plane radiogram did not indicate cauda equina tumor. Tumor occupied ratio in the dural tube by axial MRI and level of tumors by the sagittal MRI had no correlation with paralysis incidence.
Pain subsided in all cases after surgery but neurological deficits improved in only two of six paralysis patients. Two patients with malignant lymphoma and lung cancer metastasis died of primary malignant diseases within one year after surgery. Tumor recurrence has not been seen in all benign tumors.