Adult Intradural Primary Spinal Cord Tumors

Abstract

Primary spinal cord tumors represent 4.5% of all central nervous system neoplasms. They are either intradural intramedullary or intradural extramedullary. Intramedullary tumors are predominantly intrinsic gliomas (astrocytomas and ependymomas). Spinal ependymomas can usually be completely removed by separating the tumor from the spinal cord and, when complete, no further therapy is required. Astrocytomas, by contrast, infiltrate the myelon, and therefore surgery is frequently incomplete. Intradural extramedullary tumors are mostly benign (WHO grade 1) and comprise either peripheral nerve sheath tumors (neurofibromas and schwannomas) or meningiomas. Complete resection can be performed on both lesions and is often curative. Radiotherapy is indicated for primary malignant tumors (WHO grade 3 and higher) and for patients in whom surgery is contraindicated. For grade 1 and 2 tumors, the role of radiotherapy is controversial. Chemotherapy is reserved for recurrent primary spinal cord tumors with no other options. However, the lack of clinical trials for these tumors is problematic. Consequently, treatment is similar to that for intracranial histologies. Early recognition of the signs and symptoms of primary spinal cord tumors facilitates early treatment, potentially minimizes neurologic morbidity, and improves outcome. Primary treatment for almost all spinal cord tumors is surgery, with predictors of outcome being preoperative functional status, grade of tumor, and extent of resection.

Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results

“…No syrinx developed de novo after pia closure in this series. Table 5 are in line with other series: 1,3,8,20,24,27,40,52,63 ependymomas, astrocytomas, angioblastomas, and cavernomas constitute 86.4% of the total; all other pathologies are rare. Metastases, 21,45 melanocytomas, 18,25 intramedullary neuromas, 5,48 and meningiomas 10,49 are unusual intramedullary lesions mostly discussed as case reports in the literature.…”

The impact of fluorescence guidance on spinal intradural tumour surgery

“…While the majority of primary extramedullary tumors are benign, intramedullary neoplasms are usually malignant [1]. In the majority, microsurgical resection is the established treatment in extramedullary spinal tumors.…”

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

“…2 In the United States, an estimated 850-1700 new primary SCT cases are diagnosed each year. Contrary to their intracranial counterparts, primary SCTs are 10-15 times less frequent 68 and do not exhibit an association between increasing malignancy grade and age at the time of presentation.…”

“…Contrary to their intracranial counterparts, primary SCTs are 10-15 times less frequent 68 and do not exhibit an association between increasing malignancy grade and age at the time of presentation. 2,16 Based on their anatomical location with respect to the dura, these tumors are broadly classified as being extradural or intradural. The extradural spine tumors are predominantly metastatic in origin and are considered by far the most common type of SCT, whereas the intradural tumors are subclassified as extramedullary or intramedullary.…”