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Primary Spinal Tumors

(Soft tissue tumors)


H. Louis Harkey
Department of Neurosurgery
University of Mississippi
Jackson, MS

Anatomical Classification of
Spinal Cord Tumors
Extradural : Benign and malignant verteberal
tumors, tumors near the spinal cord.

Intradural tumors
Extramedullary: nerve sheath and menengial
Intramedullary: glial and other

Meningioma

Slow growing benign masses


producing indolent symptoms
~15% of all meningiomas are
spinal
5:1 female to male ratio
Typically intradural
extramedullary but can be
extadural
Most commonly thoracic in
location, Cervical second most
common

Meningioma

Clinical presentation is
indistinguishable from any other
slow growing intraspinal mass
Deficits are often dramatically
reversible
Treatment is resection by safest
route
Total resection including dural
attachment and/or cauterization
of the adjacent dura = 1%
recurrence rate
Subtotal resection has much
higher risk of recurrence

Schwannoma
Account for ~25% of intradural
& ~50% of intradural,
extramedullary tumors
70% intradural, 15% dumbbell,
5% extradural
0.3-0.4 cases/100,000 per year
Typically present in 4th and 5th
decade
No male-female predilection
Present with radicular pain,
weakness in lumbar tumors,
long tract motor signs & urinary
retention in cervical & thoracic

Schwannoma

Benign tumors
Arise from Schwann cells of the
sensory rootlets
Tumor only contains Schwann
cells and causes symptoms by
compressing neural elements
Can be removed via
hemilaminectomy in most cases
Total resection is curative
Residual tumor should be
followed long term
Long tract signs typically
improve after resection

Fewer Antoni B cells

Neurofibroma &
Neurofibromatosis
Commonly seen in NF-1
Occur more frequently
in the cervical spine in
NF-1
May be intradural,
extradural or dumbell
Often multiple
Sometimes plexiform

Neurofibroma
Benign
Fusiform expansion of the
nerve (Schwann,
perineural and neural
cells)
Difficult to get complete
resection because of the
extra-foramenal
extension and risk of
functional loss

Ganglioneuroma
Pathology
Ganglioneuroma (extradural,
dumbbell)
Gangliocytoma
Ganglioglioma (intraduralintramedullary)

Most are benign though


Gangliogliomas may become
malignant
More often seen in patients < 30
Male:female 3:2

Ganglioglioma
10% of gangliogliomas
are spinal, rest cranial
Most are paraspinal,
may extend into canal
Arise from
sympathetic NS
Rarely intramedullary
IM tumors do not have
a plane
T2

Contrast

Ependymoma

Seen in adults, 15 to 40
Male = Female
Presenting signs depend on
location
Longer duration, more severe
symptoms = less favorable
functional outcome with
surgery
Arise from ependymal lining of
the central canal & from filum
terminale
Sometimes associated with a
syrinx

Ependymoma

Arise from ependymal lining of the


central canal,
Filum origin usually myxopapillary type
Very rarely malignant
Total resection is possible in the majority
of tumors
The goal of surgery is complete
resection with good functional outcome
Functional improvement common after
resection
Progression free survival similar for total
resection vs partial resection + RT

Perivascular pseudorosettes

Astrocytoma
Occur at any age,
average age of dx is
35 to 40
Accompanying syrinx
in 40%
Occurs equally
throughout cord
Presenting sign
depend upon location

Astrocytoma
Most are grade I or II
Complete surgical resection is
impossible
RT recommended after dx
Outcomes similar for biopsy +
RT and resection + RT
Low grade recurrent tumor can
be treated with reresection

Hemangioblastoma
Highly vascular tumors
comprising 2% of spinal
cord tumors
associated with von
Hippel-Lindau, sporadic
10 times less common
than intracranial
Male predominance
Presents mid life

Hemangioblastoma
Usually dorsal
Treatment is surgical
resection
Sometimes multiple
Take feeding artery
before draining vein
Grade I neoplasm
Differential renal cell
CA (common in VHL)

Cavernous Angioma
Vascular malformation
M = F, Female more
likely to hemorrhage
More likely to present
in 3rd & 4th decade

Cavernous Angioma
Often dorsally located
and comes to surface
Hemosiderin stained
Resection with
second hemorrhage
or progressive deficit
Thin walled abnormal
vascular channels

Lipoma
Typically associated with
spinal dysrahpism
Presents like any space
occupying lesion with
progressive myelopathy
Onset of symptoms often
associated with weight
gain

Lipoma
Treatment is surgical
with debulking of the
tumor and duraplasty
Must take care not to
injure normal spinal
cord.