1. SPINAL CORD TUMORS
Dr.Ghavam Tavallaee Neurosurgeon

2. EPIDEMIOLOGY 4% to 10% of all primary CNS tumors
0.5 to 1.4 per 100,000
Three groups
Extradural (most common)
Intradural extramedullary
Intramedullary

5. CLINICAL MANIFESTATIONS
Tumors tend to be indolent
Most common symptoms
Pain
Weakness
sensory disturbances
gait change
bowel and bladder dysfunction
sexual dysfunction

6. Pain
Midline or axial spinal pain
Paraspinal pain and tenderness
Radicular pain

7. Weakness
1- may be secondary to direct involvement of the anterior horn cells or descending motor tracts
2- compression or infiltration of the ventral roots
3- external compression of the corticospinal tracts (UMN)

8. well-recognized syndromes
conus medullaris syndrome
early bowel, bladder, and sexual dysfunction
upper and lower motor neuron weakness
cauda equina syndrome
urinary retention,saddle anesthesia, lower motor neuron weakness, and reflex loss

9. Brown-Séquard syndrome
ipsilateral weakness
contralateral pain and loss of proprioception, vibration sensa-tion, and temperature sensation

10. Differential diagnosis

11. DIAGNOSTIC TESTS Plain Radiographs has not been routinely used
abnormalities in the bony structures
widening
erosion
scalloping of the posterior vertebral bodies
flattening of pedicles
scoliosis

13. Computed Tomography and Computed Tomographic Myelography
Used in patients who cannot tolerate or who have a contraindication to MRI
study of choice for visualization of osseous structures

14. Magnetic Resonance Imaging
plays a central role in the imaging of spinal cord tumors
superior anatomical localization of soft tissue masses

15. MRI Astrocytomas focal enlargements of the spinal cord
typically hypointense or isointense on T1-weighted images
hyperintense on T2-weighted images

17. Ependymomas
enhanced more intensely than are astrocytomas
more likely to have heterogeneous signals
more central on axial cuts
greater predilection for the lower spinal cord

18. Hemangioblastomas
isointense on T1
hyperintense on T2
uniformly enhanced with gadolinium

20. Intramedullary metastases
hyperintensity on T2-weighted images
homogenous enhancement after gadolinium
additional leptomeningeal deposits are often seen

22. Nerve sheath tumors
isointense signal on T1
markedly strong signal on T2 (target appearance)
enhancement is variable
multiple tumors are more likely to represent neurofibromas than schwannomas

24. Spinal meningiomas
isointense or hypointense appearance on T1
slightly hyperintense appearance on T2
intensely and homogeneously enhanced after contrast
areas of calcification are dark

26. Epidural metastatic lesions
isointense on T1
hyperintense on T2
enhanced after contrast
the entire spine must be imaged

28. MANAGEMENT
Surgery
Radiation
Chemotherapy

29. Surgery indicated for all symptomatic lesions
objectives of surgery range from gross total resection to limited biopsy for pathological diagnosis
must take into account spinal stability
hardware may be necessary

30. Most tumors are resected with a dorsal approach, laminectomy, and durotomy.
Intramedullary lesions
a midline myelotomy is required for exposure
intraoperative ultrasonography may be used
except pia-based hemangioblastomas
Intraoperative motor and somatosensory evoked potentials are routinely employed

31. The extent of resection is guided by
lesion anatomy
surgical experience
results of intraoperative monitoring
Preliminary histological diagnosis obtained from frozen sections

32. Radiation
Initial treatment of choice for extradural spinal cord compression (metastatic disease)
3000 cGy (30 Gy) administered over 2 weeks
Surgery was confined to patients presenting with extradural cord compression
without a histological diagnosis
radioresistant tumors
compression of the spinal cord by bone
recurrent cord compression after radiation therapy.

33. The efficacy of radiation for primary spinal cord tumors are controversy
No role for radiation in patients with completely resected low-grade gliomas
Image-guided frameless stereotactic radiosurgery

34. Postoperative radiation therapy
4000 to 5400 cGy
Dosages higher than 5500 cGy increased risk of radiation-induced myelopathy
Rarely employed for
Hemangioblastomas
nerve sheath tumors
spinal meningiomas
except in the case of malignant peripheral nerve sheath tumor or malignant meningioma

35. Chemotherapy
limited role in the treatment of primary spinal cord tumors, except in children
have a role in the treatment of epidural cord compression from chemosensitive tumors
such as lymphoma and myeloma

36. Goodluck