Delineating the Intradural Space: A Comparative Series of Spinal Cord Lesions

Background: Intradural spinal tumors are uncommon neoplasms that exhibit heterogeneous clinical manifestations and radiological features. They are classified as intradural extramedullary [IDEM] and intramedullary spinal cord tumors [IMSCT], both of which may cause progressive neurological deficits. Accurate neurological assessment, radiological evaluation, and histopathological confirmation are essential for diagnosis and surgical planning. Methods: We retrospectively reviewed three consecutive patients with intradural spinal tumors treated at Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia, between November 2025 and January 2026. Clinical data, preoperative MRI findings, surgical techniques, histopathological results, and postoperative neurological outcomes were analyzed. Neurological status was assessed using the Medical Research Council [MRC] scale and Frankel grade. Results: Two patients presented with IDEM lesions at the thoracic T6–T7 and lumbosacral L3–L4 levels, confirmed as metastatic carcinoma and meningothelial meningioma, respectively. One patient had a long-segment cervical IMSCT extending from C1 to C5, histopathologically diagnosed as psammomatous meningioma. All patients underwent posterior laminectomy with microsurgical tumor excision. Despite radiological decompression, persistent postoperative neurological deficits were observed during short-term follow-up. Conclusion: This case series highlights substantial clinical and radiological variability in intradural spinal tumors. Acute neurological deterioration may occur in small IDEM lesions, while extensive IMSCT involvement may paradoxically present with preserved motor function. Early diagnosis and individualized surgical management remain critical to optimize neurological outcomes. Further studies with long-term follow-up and molecular analysis are warranted.