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Intradural Spinal Tumours: Symptoms, Surgery and Recovery

Intradural spinal tumours guide

By Mr Ahmed-Ramadan Sadek, Neurosurgeon · 12 min read

🎧 Listen to this guideAbout 7 minutes. Narrated in Mr Sadek’s voice using AI technology. General information only, not personal medical advice.

On this page

Key points

  • Intradural spinal tumours grow inside the dura, the tough sac that holds the spinal cord, its nerve roots and the fluid around them. They are rare, and most are slow growing and not cancer.
  • Tumours outside the cord itself (meningiomas, schwannomas and neurofibromas) are the most common. Tumours inside the cord (ependymomas, astrocytomas and haemangioblastomas) are less common and harder to treat.
  • Symptoms build up slowly: pain along a nerve, numbness, weakness, clumsiness, trouble walking or balancing, and bladder or bowel changes. An MRI scan, usually with a contrast injection, is the key test.
  • A small tumour that causes no symptoms is often watched with repeat scans. Tumours that cause symptoms or keep growing are usually removed with microsurgery, with the nerves monitored during the operation.
  • Results for tumours outside the cord are generally good and regrowth is uncommon. Surgery inside the cord carries a higher risk of new numbness or weakness. Follow-up scans are needed, but how often varies between guidelines.

Go to A&E or call 999 straight away if you have:

  • Back pain with pain, tingling, weakness or numbness in both legs.
  • Back pain with loss of feeling around your genitals or anus.
  • Back pain with changes in your bladder or bowels, such as difficulty peeing, or peeing or pooing yourself.
  • Back pain with changes in how your penis or vagina feels during sex, or not being able to get or keep an erection.
  • New problems walking.
  • Loss of bladder or bowel control.
  • A sudden lack of co-ordination, for example with tasks like buttoning a shirt.

These can be signs that the spinal cord, or the nerves at the bottom of the spine (cauda equina syndrome), are being squeezed. Do not drive yourself: ask someone to drive you or call 999 for an ambulance.[1][2]

What does “intradural” mean?

The spinal cord and its nerve roots sit inside a tough, tube-shaped covering called the dura, filled with cerebrospinal fluid (CSF). Doctors describe a spinal tumour by where it sits in relation to the dura and the cord:[3][4]

  • Extradural: outside the dura, usually in the bones of the spine. Most are cancers that have spread from elsewhere, covered in our spinal tumours guide.
  • Intradural extramedullary: inside the dura but outside the cord, pressing on the cord or nerves from outside.
  • Intramedullary: inside the spinal cord itself.

NICE estimates that intradural tumours outside the cord make up about 15 in 100 tumours of the spinal column, and those inside the cord about 5 in 100.[4]

Outside the cordInside the cord
Main typesMeningioma, schwannoma, neurofibromaEpendymoma, astrocytoma, haemangioblastoma
Usual behaviourMostly slow growing, not cancerMostly low grade, some high grade
Complete removalPossible in most casesOften for ependymoma; less often for astrocytoma
Risk of new problems after surgeryLowerHigher

This is a simplified summary.[4][3][5][6]

How common are they?

They are rare. A large US registry study found about 0.74 new tumours of the spinal cord and its coverings per 100,000 people each year. About 7 in 10 were not cancer. The most common were meningiomas (29 in 100), nerve sheath tumours such as schwannomas (24 in 100) and ependymomas (23 in 100). Rates rose with age, peaking at 75 to 84.[7] Most are low grade: they grow slowly and do not usually spread, but they can still press on nearby nerves.[8]

The main types

Outside the cord

  • Meningioma grows from the meninges, the thin layers lining the dura. Spinal meningiomas are most common in the middle part of the back (the thoracic spine) and much more common in women.[9]
  • Schwannoma grows from the covering of a nerve root and typically causes pain running along that nerve.[9]
  • Neurofibroma is another nerve sheath tumour, often in the neck.[9] Neurofibromas are also the skin lumps seen in neurofibromatosis type 1.[10]

Inside the cord

  • Ependymoma is the most common tumour inside the cord.[11] In a review of 457 adults, most were in the neck and 8 in 10 were grade 2.[12] A type called myxopapillary ependymoma grows at the bottom of the cord, among the nerves of the cauda equina.[5]
  • Astrocytoma makes up about 30 to 40 in 100 tumours inside the cord.[6] It blends into normal cord tissue, which makes complete removal harder.[13][5]
  • Haemangioblastoma is a benign tumour with a rich blood supply, often with a fluid-filled cavity (syrinx) in the cord.[14]

Inherited conditions

Most of these tumours happen by chance. A few are linked with neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2, now also called NF2-related schwannomatosis) or von Hippel-Lindau disease.[8][15][14] NICE says people with NF1 and NF2 need monitoring, with early surgery if a tumour grows or causes symptoms.[4]

Symptoms

Symptoms depend on where the tumour is and what it presses on, and usually creep on over months or years.[8][4] They include:[8][4][16]

  • Pain running along a nerve, which NICE describes as a common first symptom.
  • Back or neck pain, or aching in the spine, arms or legs.
  • Numbness, tingling or pins and needles.
  • Weakness in the arms or legs, or clumsiness.
  • Difficulty walking or unsteadiness.
  • Bladder, bowel or sexual problems.

The NHS advises seeing a GP if back pain does not improve after resting or is worse at night.[1] These tumours are often mistaken for commoner problems. In one study of 101 people, the median time from first symptoms to diagnosis was 12 months, mainly because symptoms were put down to something else or a scan was arranged late.[16] A tumour pressing on the cord in the neck can mimic cervical myelopathy.

Tests

MRI is the main test.[3][4] A contrast dye (gadolinium) is usually injected into a vein during the scan, because many tumours take it up and show more clearly. European neuro-oncology guidelines (EANO) use contrast-enhanced MRI to measure meningiomas and to follow up spinal ependymomas.[17][5] See our guide to MRI scanning. A CT scan, an angiogram of the blood vessels or nerve tests are sometimes added.[3][4]

A scan suggests the type of tumour, but the final diagnosis comes from examining the tissue under a microscope (histology).[17][8]

What NICE says. NICE’s suspected cancer guideline (NG12) has nothing specific on spinal cord tumours; for the brain and nervous system it advises GPs to consider an urgent MRI of the brain for progressive, sub-acute loss of nervous system function.[18] NICE’s brain tumour guideline (NG99) covers brain tumours only.[19] The NICE guidance that covers intradural spinal tumours is its 2006 service guidance (CSG10), which sets out how care should be organised rather than which treatment to choose.[4]

Watching or treating?

Many small tumours are found by chance on a scan done for something else. If a tumour looks slow growing and is not causing problems, your team may suggest active monitoring: regular MRI scans and check-ups. Treatment can have permanent side effects, so monitoring may be better when these might outweigh the benefits.[8] EANO says the choice between surgery and observation for a spinal meningioma should balance the benefit of removal against the surgical risk.[17]

There is little research on how fast untreated spinal tumours grow. In one study of 56 tumours thought to be schwannomas, followed for about 3.5 years on average, some grew steadily (by a median of 13 in 100 of their volume a year) while others did not grow at all. About 16 in 100 of the stable ones later started to grow.[20]

Surgery is usually advised for a tumour that causes symptoms or is growing. For low-grade tumours, NICE says the main aim is to stop the nerves getting worse.[4] EANO notes that results of ependymoma surgery are better when the tumour is small and nerve function still good.[5]

What surgery involves

Most intradural tumours are removed from the back of the spine under general anaesthetic. For tumours outside the cord the aim is usually complete removal; inside the cord, the surgeon weighs how much to remove against the risk to the cord.[3][4] If complete removal is not possible, removing part of the tumour can still relieve pressure.[8]

  • Laminectomy removes the bony arch (lamina) at the back of the vertebrae. Laminoplasty lifts the arch and puts it back. A review of 7 observational studies found shorter stays and less later curving of the spine with laminoplasty, but the evidence was of very low quality.[21]
  • Smaller (minimally invasive) approaches suit some tumours outside the cord. A 2026 review of 20 retrospective studies with 1,471 people found fewer complications (about 7 in 100 against 16 in 100) and a stay about 3 days shorter, with similar rates of complete removal.[22]
  • Microsurgery. The surgeon opens the dura, removes the tumour under an operating microscope and closes the dura watertight to stop fluid leaking. The best closure method is uncertain.[23]

Younger people, those with an existing spinal curve, and those having surgery over several levels or inside the cord are at higher risk of the spine curving afterwards, and may need a fusion.[24] For neck tumours, see our guide to posterior neck surgery.

Nerve monitoring during surgery

NICE says intraoperative neuromonitoring should be available, because it helps identify and protect normal spinal cord.[4] Motor evoked potentials (MEPs) send a signal from the brain down the cord to the muscles. Somatosensory evoked potentials (SSEPs) check the pathways for feeling going up the cord. A D-wave records the movement signal directly from the cord, mainly for tumours inside it. If signals drop, the surgeon can pause, change approach or stop.[25][26] In one study, people monitored this way during surgery inside the cord had better movement at follow-up than matched people operated on earlier without it.[25]

What monitoring cannot do. It is a warning system, not a guarantee:[27][26][28]

  • For tumours outside the cord, when signals stayed normal about 96 in 100 people had no new weakness, but when they changed only about 57 in 100 went on to have one, so many alarms are false.[26]
  • Inside the cord, MEPs pick up most problems, while the D-wave is the best guide to whether weakness will last.[28] False alarms can mean less tumour is removed.[27]

A sample may also be examined during the operation. NICE says this is essential inside the cord, so that a high-grade astrocytoma, where removing more does not improve survival, is not chased further.[4]

Risks of surgery

  • General risks. In a US study of over 18,000 people, about 3 in 1,000 died in hospital, and blood clots in the leg or lung and wound problems each affected about 1 to 2 in 100.[29]
  • Spinal fluid leak, which can cause headaches, wound problems or infection. Reported rates range from fewer than 1 in 100 to 16 in 100. In one series of 102 people, 28 in 100 had symptoms from fluid collecting under the wound, most often a severe headache.[30]
  • New numbness or weakness. After meningioma surgery a review found complications in about 8 in 100 and good nerve function in about 79 in 100.[31] The risk is higher inside the cord: complications in about 16 in 100 after ependymoma surgery,[11] and some worsening in most people after astrocytoma surgery.[6]

Weakness present before surgery may not fully recover. Poor function beforehand and a longer delay to surgery predicted worse results after meningioma surgery.[31]

Recovery

You may spend a few days in a high dependency unit or on the ward.[8] Stays are shorter after smaller operations and laminoplasty.[22][21] In the US study, about 29 in 100 people went on to a rehabilitation unit rather than straight home.[29] NICE says rehabilitation should be available,[4] and you may be referred for physiotherapy, occupational therapy and emotional support. Tiredness and difficulty getting around can last a while.[8] After meningioma surgery, quality of life improved quickly and many people returned to work.[31] Your team will advise on work, lifting and exercise. You must tell the DVLA (or the DVA in Northern Ireland) about a spinal tumour diagnosis.[8]

Outcomes and recurrence

In one series of 120 operations, nerve function improved after 49, stayed the same after 67 and got worse after 4.[32] Results differ by tumour type:

TumourWhat studies report
MeningiomaRegrowth about 6 in 100 in a pooled review,[31] 1 to 15 in 100 across individual series.[17]
Schwannoma89 in 100 free of regrowth at 5 years. Regrowth 3 in 100 after complete removal of a single schwannoma without neurofibromatosis, 32 in 100 in other cases.[33]
EpendymomaComplete removal in about 83 in 100; regrowth in about 7 in 100.[12]
AstrocytomaRegrowth in about 41 in 100, more with high grade or incomplete removal.[6] Complete removal was linked with longer survival.[13]

Across ependymomas and astrocytomas, 79 in 100 people had stable or better nerve function 6 months after surgery.[34] The outlook for high-grade tumours inside the cord is much poorer.[4]

Follow-up scans

NICE says follow-up needs regular MRI and examination.[4] How often depends on the tumour and treatment,[8] and guidance varies:

  • Meningioma: EANO suggests yearly MRI for 5 years then every 2 years for grade 1, and every 6 months for grade 2. This guidance covers meningiomas in general, most of which are in the head.[17]
  • Ependymoma: EANO recommends an MRI after surgery and long-term follow-up, as some come back late, without a fixed interval.[5]
  • Schwannoma: one study questioned yearly MRI after complete removal of a single schwannoma in people without neurofibromatosis.[33]

Radiotherapy

Radiotherapy may be used when surgery is not possible, when tumour is left behind, or if it comes back.[8] EANO recommends it after incomplete removal of a grade 2 ependymoma and for all grade 3 ependymomas.[5] For astrocytoma its value is less clear, with one review suggesting benefit only for high-grade tumours.[34] A 2026 review of targeted radiosurgery found long-term control in about 94 in 100, though studies defined control differently.[35] Drug treatment is rarely used.[8]

Your care team

NICE recommends that every intradural spinal tumour is discussed at a specialist multidisciplinary team (MDT) meeting, including a spinal surgeon, a neuroradiologist (scan specialist), a neuropathologist (who confirms the tumour type and grade), a clinical nurse specialist and therapists. Care should be led by teams who also treat other spinal problems, including emergencies, and you should have a named key worker.[4] If you are unsure about the plan, you can ask for a second opinion.

The evidence and its limits

These tumours are rare, so almost all the evidence comes from retrospective case series, often from single specialist centres and outside the UK. There are no randomised trials comparing surgery with observation or one operation with another.[21][22] NICE’s service guidance dates from 2006.[4] That is why figures here are given as ranges, and why your own team’s advice, based on your scan and symptoms, matters most.

When to get help

See your GP if back pain does not improve after a few weeks, or is worse at night.[1] Ask for an urgent GP appointment or contact NHS 111 if you have heaviness or weakness in your arms or legs, pins and needles in an arm with neck or arm pain, or pain between your shoulder blades.[2]

For emergencies, see the red box above. If you are being monitored for a tumour or have had one removed, talk to your specialist doctor or nurse if you are worried about new or changing symptoms between scans.[8]

Questions to ask

  • Is my tumour outside the spinal cord or inside it, and what type do you think it is?
  • Is it safe to watch it with scans, and what would make you recommend surgery?
  • What are my chances of new numbness, weakness or a fluid leak?
  • Will nerve monitoring be used, and do you expect to remove all of it?
  • Has my case been discussed at a spinal tumour MDT meeting?
  • How often will I need scans afterwards, and for how long?

Frequently asked questions

Is an intradural tumour cancer?

Usually not. In a large US registry study, about 7 in 10 tumours of the spinal cord and its coverings were not cancer.[7] Most are low grade and grow slowly. A few are high grade, grow faster and can spread along the brain and spinal cord, but they rarely spread to other parts of the body.[8]

My tumour was found by chance. Does it need to come out?

Not always. If it looks slow growing and is not causing symptoms, your team may suggest monitoring with regular MRI scans instead of surgery.[8] In one study of tumours thought to be schwannomas, some grew steadily and others did not grow at all.[20] Surgery is usually advised if the tumour causes symptoms or keeps growing.[4]

Could surgery leave me weaker?

It can, but for most tumours outside the spinal cord the risk is low and nerve function often improves.[31][32] The risk is higher for tumours inside the cord.[6][11] Nerve monitoring during surgery warns the surgeon of problems, but it cannot prevent every one.[27][26]

How long will I be in hospital?

It varies. Macmillan says you may be looked after in a high dependency unit or on the ward for a few days after surgery.[8] Smaller operations were linked with stays about 3 days shorter in one review.[22] Some people need a period of rehabilitation afterwards.[29]

Can the tumour come back?

It can, but for most tumours outside the cord this is uncommon. Recurrence was about 6 in 100 after meningioma surgery in one review,[31] and 3 in 100 after complete removal of a single schwannoma in people without neurofibromatosis.[33] It is more common after incomplete removal and for higher-grade tumours, particularly astrocytomas.[6]

Will I need radiotherapy?

Most people with a tumour that has been removed completely do not. Radiotherapy may be used when surgery is not possible, when some tumour is left, for higher-grade tumours, or if the tumour comes back.[8][5]

How often will I need scans?

It depends on the tumour and your treatment, and guidelines differ. For meningiomas, EANO suggests yearly MRI for 5 years then every 2 years.[17] For ependymomas it recommends long-term follow-up.[5] One study questioned yearly scans after complete removal of a single schwannoma.[33]

Can I still drive?

You must tell the DVLA (or the DVA in Northern Ireland) if you are diagnosed with a spinal tumour. Whether you can drive depends on your symptoms; your doctor will advise you.[8]

Further reading

References

  1. NHS. Back pain. NHS website; page last reviewed 5 March 2026. Link
  2. NHS. Cervical spondylosis. NHS website; page last reviewed 2 August 2023. Link
  3. Ottenhausen M, Ntoulias G, Bodhinayake I, et al. Intradural spinal tumors in adults: update on management and outcome. Neurosurg Rev. 2019;42(2):371-388. Link
  4. National Institute for Health and Care Excellence. Improving outcomes for people with brain and other central nervous system tumours (CSG10). Published 28 June 2006, last reviewed 9 March 2017. Link
  5. Rudà R, Reifenberger G, Frappaz D, et al. EANO guidelines for the diagnosis and treatment of ependymal tumors. Neuro Oncol. 2018;20(4):445-456. Link
  6. Hoang H, Mellal A, Dulloo M, et al. Determining the predictors of recurrence or regrowth following spinal astrocytoma resection: a systematic review and meta-analysis. Brain Sci. 2024;14(12):1226. Link
  7. Schellinger KA, Propp JM, Villano JL, McCarthy BJ. Descriptive epidemiology of primary spinal cord tumors. J Neurooncol. 2008;87(2):173-179. Link
  8. Macmillan Cancer Support. Spinal cord tumours. Reviewed 1 May 2024, next review 1 May 2027. Link
  9. Koeller KK, Shih RY. Intradural extramedullary spinal neoplasms: radiologic-pathologic correlation. Radiographics. 2019;39(2):468-490. Link
  10. NHS. Neurofibromatosis type 1 (NF1). NHS website; page last reviewed 9 April 2025. Link
  11. Artha YW, Widhiyanto L, Airlangga PA, Hidayat AR, Irianto KA. Clinical characteristics, management, and outcomes of intramedullary spinal cord ependymomas: a systematic review and meta-analysis. Spine Surg Relat Res. 2026;10(2):151-163. Link
  12. Farooqi S, Tebha SS, Qamar MA, et al. Clinical characteristics, management, and outcomes of intramedullary spinal cord ependymomas in adults: a systematic review. World Neurosurg. 2023;173:237-250.e8. Link
  13. Golpayegani M, Edalatfar M, Ahmadi A, et al. Complete versus incomplete surgical resection in intramedullary astrocytoma: systematic review with individual patient data meta-analysis. Global Spine J. 2023;13(1):227-241. Link
  14. Jankovic D, Hanissian A, Rotim K, Splavski B, Arnautovic KI. Novel clinical insights into spinal hemangioblastoma in adults: a systematic review. World Neurosurg. 2022;158:1-10. Link
  15. NHS. Neurofibromatosis type 2 (NF2). NHS website; page last reviewed 24 April 2025. Link
  16. Segal D, Lidar Z, Corn A, Constantini S. Delay in diagnosis of primary intradural spinal cord tumors. Surg Neurol Int. 2012;3:52. Link
  17. Goldbrunner R, Stavrinou P, Jenkinson MD, et al. EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol. 2021;23(11):1821-1834. Link
  18. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral (NG12). Published 23 June 2015, last updated 15 April 2026. Link
  19. National Institute for Health and Care Excellence. Brain tumours (primary) and brain metastases in over 16s (NG99). Published 11 July 2018, last updated 29 January 2021. Link
  20. Lee CH, Chung CK, Hyun SJ, et al. A longitudinal study to assess the volumetric growth rate of spinal intradural extramedullary tumour diagnosed with schwannoma by magnetic resonance imaging. Eur Spine J. 2015;24(10):2126-2132. Link
  21. Byvaltsev V, Polkin R, Kalinin A, et al. Laminoplasty versus laminectomy in the treatment of primary spinal cord tumors in adult patients: a systematic review and meta-analysis of observational studies. Asian Spine J. 2023;17(3):595-609. Link
  22. Patel S, Nischal SA, Nallanukala GS, et al. Minimally invasive versus open surgery for the management of intradural extramedullary tumors: a systematic review and meta-analysis. Eur Spine J. 2026 (online ahead of print 31 July 2026). Link
  23. Syal A, Cozzi FM, Vazquez S, et al. Dural closure techniques and cerebrospinal fluid leak incidence after resection of primary intradural spinal tumors: a systematic review. Clin Spine Surg. 2024;37(7):291-295. Link
  24. Szyduczyński M, Korneliussen J, Landé O, et al. Risk factors analysis for spinal deformity following resection of intradural spinal cord tumors from posterior approach: systematic review and meta-analysis. Eur Spine J. 2025;34(8):3464-3473. Link
  25. Sala F, Palandri G, Basso E, et al. Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery. 2006;58(6):1129-1143. Link
  26. Ishida W, Casaos J, Chandra A, et al. Diagnostic and therapeutic values of intraoperative electrophysiological neuromonitoring during resection of intradural extramedullary spinal tumors: a single-center retrospective cohort and meta-analysis. J Neurosurg Spine. 2019;30(6):839-849. Link
  27. Rijs K, Klimek M, Scheltens-de Boer M, Biesheuvel K, Harhangi BS. Intraoperative neuromonitoring in patients with intramedullary spinal cord tumor: a systematic review, meta-analysis, and case series. World Neurosurg. 2019;125:498-510.e2. Link
  28. Thomas S, Addanki RND, Murugan CK, et al. A systematic review and meta-analysis to compare the diagnostic accuracy of direct-waves and myogenic motor-evoked potential neuromonitoring during intramedullary spinal cord tumor resection. Oper Neurosurg. 2026;30(4):513-524. Link
  29. Kalakoti P, Missios S, Menger R, et al. Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18,297 patients across 774 US hospitals using the National Inpatient Sample (2002-2011). Neurosurg Focus. 2015;39(2):E4. Link
  30. Nakashima H, Ota K, Ito S, et al. Incidence and risk factors of cerebrospinal fluid leakage related complications after spinal intradural tumor resection. Nagoya J Med Sci. 2025;87(3):521-527. Link
  31. El-Hajj VG, Pettersson-Segerlind J, Fletcher-Sandersjöö A, Edström E, Elmi-Terander A. Current knowledge on spinal meningiomas: surgical treatment, complications, and outcomes. A systematic review and meta-analysis (part 2). Cancers (Basel). 2022;14(24):6221. Link
  32. Pojskić M, Bopp M, Saß B, Nimsky C. Single-center experience of resection of 120 cases of intradural spinal tumors. World Neurosurg. 2024;187:e233-e256. Link
  33. Halvorsen CM, Rønning P, Hald J, et al. The long-term outcome after resection of intraspinal nerve sheath tumors: report of 131 consecutive cases. Neurosurgery. 2015;77(4):585-592. Link
  34. Hamilton KR, Lee SS, Urquhart JC, Jonker BP. A systematic review of outcome in intramedullary ependymoma and astrocytoma. J Clin Neurosci. 2019;63:168-175. Link
  35. Nordin EOR, Sanker V, Heesen P, et al. Stereotactic radiosurgery (SRS) for primary intradural spinal tumors: a systematic review and meta-analysis. Neurosurg Rev. 2026;49(1):267. Link

This article is general information and is not a substitute for advice about your own situation. Please speak to your GP or specialist before making any change to your treatment.

Last checked: October 2026