The Association of Hydrocephalus with Intramedullary Spinal Cord Tumors: A Series of 25 Patients

Abstract

171 patients with intramedullary spinal cord tumors were operated on, of which 25 patients (15%), mostly children, developed symptomatic hydrocephalus. Twenty patients (12%) had malignant tumors, with 13 of the 20 cases (63%) complicated by increased intracranial pressure and ventriculomegaly. Of the remaining 151 patients with benign tumors (89%), only 12 (8%) developed symptomatic hydrocephalus. In an effort to understand the relationship between hydrocephalus and intramedullary spinal cord tumor, the authors analyze the level and histology of the neoplasm, as well as its association with spinal cysts. A review of the neurosurgical literature reveals that 34 similar cases of hydrocephalus associated with intramedullary spinal cord tumors have been reported to date. The authors note that the presence of hydrocephalus in patients with malignant intramedullary astrocytomas is associated with a shorter rate of survival than in those patients with high-grade lesions but without hydrocephalus, apparently due to rapid tumor progression. The ventriculomegaly seen with benign spinal cord gliomas has no statistically significant effect upon longterm prognosis.

Infantile Spinal Cord Tumor Presenting as Hydrocephalus

“…Obviously, when tumors of the cervical spinal cord extend in a rostral direction to the cervicomedullary junction, the CSF pathways may be obstructed and hydrocephalus may result. 7 In our patient, the tumor that was eventually diagnosed was indeed in this location, although the CT scan on presentation showed no evidence of a craniospinal lesion, and the child was well for six months after shunting. Interestingly, a literature review of 65 cases of spinal cord tumor and hydrocephalus showed the most common location for the tumor to be the thoracolumbar region.…”

“…[3][4][5][6] In a single institution series of 171 patients with intramedullary spinal cord tumors, Rifkinson-Mann et al found 25 subjects with symptomatic hydrocephalus. 7 In five of these, hydrocephalus was the presenting feature, and shunt procedures were carried out. In four, the spinal cord tumor was diagnosed one month later, and in the other patient, after six months.…”

“…9 The pathogenesis of increased intracranial pressure or hydrocephalus that occurs in association with spinal cord tumors remains speculative. A variety of mechanisms have been suggested, the principal one being the impaired absorption of CSF, the causes of which include elevated protein, 5 basal arachnoiditis due to tumor infiltration into the basal cisterns, 7 and compression of the venous spinal plexus by tumor. 1 Kudo et.…”

Resection of Multiple Neurinomas of the Cauda Equina Improves Normal Pressure Hydrocephalus

“…Because the CSF protein level of our patient was elevated, his characteristics are more reminiscent of sNPH. Previous reports show that spinal cord tumors can be associated with NPH [4][5][6][7][8][9]. Hyperviscosity in cases with elevated CSF proteins produced by spinal cord tumors may cause obstructive hydrocephalus.…”

Delayed hydrocephalus as an unusual complication of a stab injury to the spine

“…Hydrocephalus as a result of spinal pathology is rare, and has been reported with spinal tumors where the pathogenesis may be disruption 11 of the CSF flow, impaired absorption due to elevated CSF protein, tumor infiltration into the basal cisterns and even compression 12 of the spinal venous plexus by tumor. In our patient, we consider that the pathogenesis may be related to the high level of the penetrating injury leading to blood from the site of injury (Figure 1) entering the basal cisterns and impairing the absorption of the CSF by the arachnoid villi over the hemispheres, hence leading to a communicating hydrocephalus.…”