Intradural spinal metastases are rare manifestations of systemic malignancies and include intramedullary (IM) and intradural extramedullary (IDEM) lesions with distinct anatomical and biological characteristics. Owing to their rarity, the optimal surgical indications and expected neurological outcomes remain unclear. This study aimed to compare the clinical presentation, surgical feasibility, and postoperative neurological recovery between IM and IDEM spinal metastases. We retrospectively reviewed 15 consecutive patients (mean age 49.7 ± 19.2 years) who underwent surgical treatment for intradural spinal metastases at our institution between 2010 and 2024. The lesions were classified as IM (n = 6) or IDEM (n = 9) based on radiological and intraoperative findings. Patient demographics, neurological symptoms, tumor location, operative variables, extent of resection, adjuvant therapy, and perioperative complications were analyzed. Neurological function was evaluated preoperatively and postoperatively using the Modified McCormick Scale (MMCS). IM lesions were most often thoracic (66.7%), whereas IDEM lesions occurred at various spinal levels. Gross total resection was achieved in only one IM (16.7%) and four IDEM (44.4%) lesions. No perioperative complications were observed. Preoperatively, half of the patients with IM were classified as MMCS grade V, whereas most patients with IDEM retained their ambulatory function. Postoperatively, neurological improvement was observed in five patients (33.3%), no change in six (40.0%), and deterioration in four (26.7%). MMCS analysis showed improvement in three IM (50.0%) and two IDEM (22.2%) patients; however, IDEM lesions achieved better final grades, with several patients improving to grades I–II. In contrast, half of the patients with IM remained at grade V. Surgery for intradural spinal metastases is safe and can maintain or improve neurological function in patients. IDEM lesions are more amenable to complete resection and functional recovery, whereas IM lesions generally require limited, function-preserving procedures for diagnosis and palliation within a multidisciplinary treatment framework.