Clinical and radiological differentiation of thoracic spinal meningiomas and schwannomas: insights from the Sapporo-Iowa Joint Study

Satoka Shidoh; Kazutoshi Hida; Toru Sasamori; Ikuma Echizenya; Shunsuke Yano; Prabin Shrestha; Jangbo Lee; Matthew A Howard III; Satoshi Yamaguchi

doi:10.1016/j.wneu.2025.124509

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Clinical and radiological differentiation of thoracic spinal meningiomas and schwannomas: insights from the Sapporo-Iowa Joint Study

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Clinical and radiological differentiation of thoracic spinal meningiomas and schwannomas: insights from the Sapporo-Iowa Joint Study

Satoka Shidoh, Kazutoshi Hida, Toru Sasamori, Ikuma Echizenya, Shunsuke Yano, Prabin Shrestha, Jangbo Lee, Matthew A Howard III and Satoshi Yamaguchi

World neurosurgery, Vol.204, 124509

12/2025

DOI: 10.1016/j.wneu.2025.124509

PMID: 41005658

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Abstract

Meningiomas and schwannomas are the most common intradural extramedullary spinal tumors, but differentiating between them remains challenging. This study aimed to identify clinical and growth pattern differences between the two thoracic spinal tumors beyond previously reported imaging signs. We retrospectively reviewed 114 patients with histologically confirmed thoracic spinal meningiomas (n = 74) and schwannomas (n = 40) from the Sapporo-Iowa Joint Study. Demographics, clinical symptoms, tumor location, imaging findings (dural tail sign, ginkgo leaf sign, cyst), tumor volume, and spinal cord compression metrics were analyzed. Meningiomas demonstrated a higher female predominance (88% vs. 48%, p < 0.001) and older mean age at onset (69.2 vs. 59.4 years, p < 0.001). Schwannomas were more frequent in the lower thoracic spine (80%, p < 0.001). The dural tail sign was more common in meningiomas (53% vs. 20%, p < 0.001), whereas cysts occurred exclusively in schwannomas (35%, p < 0.001). Motor deficits were more frequent in meningiomas (91% vs. 55%, p < 0.001), whereas pain predominated in schwannomas (83% vs. 28%, p < 0.001). Schwannomas had a larger median volume but caused less cord compression. Multivariate analysis identified three independent predictors for schwannoma: pain (odds ratio [OR], 12.1), lower thoracic location (OR, 9.67), and tumor height (OR, 1.30). A scoring system based on these predictors showed strong diagnostic performance (area under the curve [AUC] = 0.874). Thoracic spinal meningiomas and schwannomas exhibit distinct clinical and radiological profiles. The proposed scoring system may support preoperative differentiation and decision-making.

meningioma

schwannoma

thoracic spine

predictive factors

Details

Title: Subtitle: Clinical and radiological differentiation of thoracic spinal meningiomas and schwannomas: insights from the Sapporo-Iowa Joint Study
Creators: Satoka Shidoh - University of Iowa
Kazutoshi Hida - Sapporo Azabu Neurosurgical Hospital
Toru Sasamori - Sapporo Azabu Neurosurgical Hospital
Ikuma Echizenya - Sapporo Azabu Neurosurgical Hospital
Shunsuke Yano - Sapporo Azabu Neurosurgical Hospital
Prabin Shrestha - University of Iowa
Jangbo Lee - University of Iowa
Matthew A Howard III - University of Iowa, Iowa Neuroscience Institute
Satoshi Yamaguchi - University of Iowa Health Care
Resource Type: Journal article
Publication Details: World neurosurgery, Vol.204, 124509
DOI: 10.1016/j.wneu.2025.124509
PMID: 41005658
NLM abbreviation: World Neurosurg
ISSN: 1878-8750
eISSN: 1878-8769
Publisher: ELSEVIER SCIENCE INC
Language: English
Electronic publication date: 09/24/2025
Date published: 12/2025
Academic Unit: Neurology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
Record Identifier: 9984966340402771

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