Enlarged Neural Foramen

Enlarged Neural Foramen

Bryson Borg, MD



  • Nerve Sheath Tumor

    • Schwannoma

    • Neurofibroma

  • Perineural Root Sleeve Cysts

  • Dural Dysplasia

  • Lytic Metastasis to Vertebral Body or Pedicle

Less Common

  • Osteomyelitis, Granulomatous

  • Neuroblastic Tumor

  • Post-Traumatic Pseudomeningocele

  • Meningocele, Lateral

  • Vertebral Artery Ectasia or Aneurysm

  • Osteolytic Primary Bone Tumor

    • Aneurysmal Bone Cyst

    • Plasmacytoma

Rare but Important

  • Hypoplastic or Absent Pedicle


Key Differential Diagnosis Issues

  • CT useful to distinguish bony remodeling (benign or low grade mass) from osteolysis (aggressive neoplasm, infection)

Helpful Clues for Common Diagnoses

  • Nerve Sheath Tumor

    • Transforaminal “dumbbell-shaped” enhancing soft tissue mass

  • Perineural Root Sleeve Cysts

    • Circumscribed foraminal masses, often multiple, tend to be small (1-3 cm)

    • Contents follow CSF, no enhancement, ± opacification with myelography

  • Dural Dysplasia

    • Transmission of chronic CSF pressures by weakened dura leads to bony remodeling and expansion of lumbosacral canal and neuroforamina

    • Can be seen with neurofibromatosis type 1, Marfan disease, homocystinuria, Ehlers-Danlos, and ankylosing spondylitis

  • Lytic Metastasis to Vertebral Body or Pedicle

    • Destructive process with loss of cortex, wider zone of transition to normal bone, multiple osseous lesions

    • Renal, lung, and breast are common primaries to develop osteolytic metastases

Helpful Clues for Less Common Diagnoses

Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Enlarged Neural Foramen

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