Primary spinal tumors soft tissue tumors
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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

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Primary Spinal Tumors (Soft tissue tumors)

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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 (intradural-intramedullary)

  • 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

T 2

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

  • ¼ associated with von Hippel-Lindau, ¾ 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.


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