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

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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

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Meningioma

• Slow growing benign masses producing indolent
  symptoms
• 15 of all meningiomas are spinal
• 51 female to male ratio
• Typically intradural extramedullary but can be
  extadural
• Most commonly thoracic in location, Cervical
  second most common

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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

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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

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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
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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

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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

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Ganglioneuroma

• Pathology
• Ganglioneuroma (extradural, dumbbell)
• Gangliocytoma
• Ganglioglioma (intradural-intramedullary)
• Most are benign though Gangliogliomas may become
  malignant
• More often seen in patients lt 30
• Malefemale 32

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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
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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

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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
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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

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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

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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

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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)

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Cavernous Angioma

• Vascular malformation
• M F, Female more likely to hemorrhage
• More likely to present in 3rd 4th decade

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Cavernous Angioma

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

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Lipoma

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

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Lipoma

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