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
• 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.