Primary Spinal Tumors(Soft tissue tumors)

H. Louis HarkeyDepartment of Neurosurgery

University of MississippiJackson, 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 planeT 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.