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PubMed This is a summary of 21 peer-reviewed journal articles Updated
Neurosurgery

Understanding Your Pathology and MRI Report

At a Glance

A spinal meningioma report combines MRI location with pathology findings such as WHO grade, histological subtype, calcification, and selected molecular markers. Together, these details help the care team assess tumor behavior and plan safe surgery.

When you receive your MRI or pathology report, you may encounter technical language that describes the tumor’s location and biological makeup. Understanding these terms can help you have a more informed conversation with your surgical team.

Mapping the Location: Front vs. Back

Your MRI report will often use terms to describe where the tumor sits in relation to your spinal cord. This location is critical because it determines the “road map” your surgeon will use to reach the tumor [1].

  • Dorsal: The tumor is toward the back of the spinal canal. These are generally the most straightforward to access because the surgeon can reach them directly from the back without moving the spinal cord [2].
  • Ventral: The tumor is at the front of the spinal canal, “behind” the spinal cord from the surgeon’s perspective. These can be more technically complex because the surgeon may need to carefully work around or gently move the spinal cord to reach the tumor [3][4].
  • Lateral or Dorsolateral: The tumor is off to the side or the back-side. This is a common location that often allows for good access with minimal cord movement [1][5].

While ventral tumors were traditionally considered higher risk, modern surgical techniques—such as using specialized corridors or “keyhole” approaches—have improved access [6][7]. However, for tightly adherent or calcified tumors, a subtotal resection (leaving a small piece behind intentionally) can be the safest deliberate outcome to protect the cord.

WHO Grading: Assessing the “Personality”

The World Health Organization (WHO) assigns a grade to meningiomas based on how the cells look under a microscope and their genetic features. This grade helps provide context for how the tumor might behave, though the extent of surgery and follow-up also strongly matter [8].

  • WHO Grade 1 (Benign): This is the most common type for the spine, accounting for the vast majority of cases [9][10]. These are slow-growing and have the lowest risk of returning after surgery.
  • WHO Grade 2 (Atypical): These cells grow slightly differently than Grade 1 and show more active features [11].
  • WHO Grade 3 (Malignant/Anaplastic): These are extremely rare in the spine and grow more aggressively [9].

Histological Subtypes

Your pathology report may also name a histological subtype, which describes the specific pattern of the cells. The two most common subtypes in the spine are:

  • Psammomatous: These tumors contain “psammoma bodies,” which are tiny, round areas of calcium [12]. If your tumor is described this way, it may be “gritty” or hard (calcified), which your surgeon takes into account during removal [13].
  • Meningothelial: This is a very common, classic pattern of meningioma cells [14].

The Role of Molecular Markers

In 2021, the WHO updated how meningiomas are graded by including “molecular markers”—specific changes in the tumor’s DNA. Molecular testing is not necessarily performed for every spinal meningioma, and a report without it is not necessarily incomplete; your pathologist will decide if these tests are useful [15].

  • TERT Promoter Mutation: If this specific mutation is found in the tissue, the tumor can be classified as Grade 3, regardless of how it looks [16][17].
  • CDKN2A/B Deletion: A “homozygous” (complete) loss of this gene can also classify a tumor as Grade 3 [15][18].
  • NF2 and Chromosome 22q: Many spinal meningiomas show a loss of part of chromosome 22q or mutations in the NF2 gene [19]. While these are very common findings in meningiomas and don’t necessarily make them “worse,” they help doctors understand the tumor’s biology [20].

By combining the MRI location, the cell appearance, and these molecular clues, your care team builds a complete picture of your tumor to guide your recovery [21].

Common questions in this guide

What do ventral, dorsal, and lateral mean on a spinal meningioma MRI?
These terms describe where the tumor sits in relation to the spinal cord. Dorsal means toward the back, ventral means toward the front, and lateral or dorsolateral means toward the side or back-side. The location helps the surgeon plan the safest route to the tumor.
How does the WHO grade affect what my spinal meningioma report means?
WHO Grade 1 tumors are the most common spinal meningiomas and are usually slow-growing, with the lowest risk of returning after surgery. Grade 2 tumors have more active or atypical features, while Grade 3 tumors are rare in the spine and behave more aggressively. The grade is considered along with how much tumor was removed and the follow-up plan.
Does a psammomatous spinal meningioma mean the tumor is calcified?
Psammomatous meningiomas contain small calcium deposits called psammoma bodies. This can make the tumor gritty or hard, which may affect how the surgeon approaches and removes it. The subtype alone does not determine the tumor's WHO grade.
Is molecular testing required for every spinal meningioma?
No. Molecular testing is not performed for every spinal meningioma, and a report without these tests is not necessarily incomplete. The pathologist decides whether testing is useful based on the tumor's features and the clinical situation.
Can genetic findings change the grade of a spinal meningioma?
Yes. A TERT promoter mutation or complete loss of both copies of CDKN2A or CDKN2B can support a WHO Grade 3 classification, even when the cells do not appear highly aggressive under the microscope. NF2 changes and loss of part of chromosome 22q are common in meningiomas and do not automatically mean the tumor is more severe.
Why might a surgeon leave part of a spinal meningioma behind?
If a tumor is tightly attached to the spinal cord or heavily calcified, removing every visible part may increase the risk of cord injury. A planned subtotal resection can leave a small piece behind when that is the safer choice. Your surgical team may combine this decision with the tumor's location, grade, and follow-up imaging.

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References

References (21)
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This page explains spinal meningioma MRI and pathology terms for informational purposes only and does not replace professional medical advice. Your neurosurgeon and pathologist can interpret your specific reports and discuss your surgical plan.

Guide contents Spinal meningioma
Research & Literature
02 Symptoms and the Path to Diagnosis 04 Standard of Care