A25. Signs of tumors of the spine and spinal space Flashcards
what % of tumor related death are due to primary CNS tumor
- 2 % of tumor related deaths are due to primary
CNS
and out of these - 85 % are intracranial and
- 15 % are spinal.
what % of tumors are intracranial VS spinal
- 85 % are intracranial and
- 15 % are spinal.
Aim of treatment of spinal tumors
is to maintain QOL, not only to
prolong the survival.
etiology of CNS tumors
- most common are metastatic tumors, and
- meningioma,
- schwannoma
- ependymoma.
classification of spinal cord tumors
by location
* Extradural tumors (55 %)
* Intradural / extramedullary tumors (40 %)
* Intramedullary tumors (5 %)
Extradural tumors - etiology
- Primarily vertebral metastases (solitary or multiple) - mostly in thoracic region
- Mostly lung, breast, GI and prostate.
- Also malignant melanoma, lymphoma and multiple myeloma
most common location for extradural spinal cord tumors
- Primarily vertebral metastases (solitary or multiple) - mostly in thoracic region
most common cancers that metastatize to Spinal cord
- lung,
- breast,
- GI
- prostate.
- malignant melanoma,
- lymphoma
- multiple myeloma
Extradural tumors complication
Leading to vertebral compression
and paravertebral - epidural spread,
which causes spinal cord or nerve root compression.
Rare extradural tumors
● Osteoid osteomas
● Osteoblastomas
● Chondromas
● Schwannoma/Neurofibromas (shape of sandglass growing into thorax or abdomen)
● Hemangiomas
Extradural tumors of spinal cord- symptoms
● Pain usually first symptom, and it’s not alleviated by rest
*Radicular pain
● Signs of spinal cord compression, then transverse lesion
● Usually more motor than sensory symptoms (sensitivity of corticospinal tract)
● At diagnosis: paraparesis in 76 % of cases
● Neurological signs in 20-40 %
*Decreases chance of successful surgical intervention
what is usually the first symptom in extradural spinal tumor
● Pain usually first symptom, and it’s not alleviated by rest
*Radicular pain
if there are Signs of spinal cord compression in suspicioun of extradural spinal tumor hence it’s a
then transverse lesion
are motor or sensory symptoms more in extradural spinal cord tumor?
● Usually more motor than sensory symptoms (sensitivity of corticospinal tract)
at diagnosis of extradural tumor , what can be seen in most cases
At diagnosis: paraparesis in 76 % of cases
How does presence of neurological signs affect the surgical intervention
Neurological signs in 20-40 %
*Decreases chance of successful surgical intervention
paraparesis def
partial paralysis of the lower limbs
diagnosis of Extradural tumors
● MRI has the main role
● X-ray can detect in 67-85 % of cases - mostly osteolytic lesions (sometimes vertebral collapse)
● CT and bone scan can provide additional information
what can CT detect in extradural tumors
67-85 % of cases - mostly osteolytic lesions (sometimes vertebral collapse)
Extradural tumors treatment
● Surgical intervention
○ Resolve stability of spine
○ Decompression
○ Improve QOL
● Radiotherapy
○ First choice in SCLC if no pathological fracture or spinal cord compression
● Chemotherapy
○ Depends on primary tumor
● Vertebroplasty (bone cement is injected into fractured vertebra
what is the First choice of treatment in SCLC
if NO pathological fracture or
spinal cord compression
● Radiotherapy
when is Vertebroplasty used in extradural tumor treatment
In inoperable multiple vertebral metastases to alleviate local pain
(bone cement is injected into fractured vertebra)
can chemotherapy be used to treat extradural tumors?
Depends on primary tumor
Intradural-extramedullary tumors location
Located on lateral or posterior surface of the spinal cord
Intradural-extramedullary tumors histology
Histologically these tumors are
● Neurofibromas/schwannomas (if multiple: Recklinghausen’s disease)
● Meningiomas
● Ependymomas (from filum terminale)
● Lipomas
if multiple Neurofibromas/schwannomas what is it called
Recklinghausen’s disease
Intradural-extramedullary tumors symptoms
● Chronic radicular or local pain first (lasting for months)
● Later: signs of nerve root or spinal cord dysfunction
later symtpoms of Intradural-extramedullary tumors
signs of nerve root
or
spinal cord dysfunction
Intradural-extramedullary tumors treatment
● Surgical
● Radiotherapy
(in malignant tumors and some CSF metastases - eg medulloblastoma, ependymoma)
● Intrathecal chemotherapy (in disseminated leptomeningeal lymphoma
when is RT used in Intradural-extramedullary tumors
● Radiotherapy
* in malignant tumors
* some CSF metastases
eg medulloblastoma, ependymoma)
when is Intrathecal chemotherapy used in Intradural-extramedullary tumors
in disseminated leptomeningeal lymphoma
what are Neurofibromas/Schwannomas
Slow growing benign tumors
where do Neurofibromas/Schwannomas occur
- occur at any level and usually from posterior nerve roots
- Either lie entirely within spinal canal or “dumbbell” through intervertebral foramen (“hourglass”) - can present as a mass in thorax or posterior
abdominal wall.
what can present as a mass in thorax or posterior
abdominal wall
Neurofibromas/Schwannomas
lie entirely within spinal canal
or “dumbbell” through intervertebral
foramen (“hourglass”)
where are Neurofibromas/Schwannomas found in spinal cord
lie entirely within spinal canal or “dumbbell” through intervertebral
foramen (“hourglass”) - can present as a mass in thorax or posterior
abdominal wall.
Neurofibromas/Schwannomas-
If suspicion of Von Recklinghausen’s disease
look for café au lait spots
in skin
Meningiomas- age and gender
elderly, and more common in females
Meningiomas location
Usually arise in thoracic region and are almost always intradural
what are Meningiomas
Slow growth - considerable cord flattening can occur before symptoms occur
what can happen to spinal cord in meningiomas before symptoms occur
considerable cord flattening can occur before symptoms occur
Meningiomas diagnostics
MRI or CT myelography will identify lesion
Meningiomas treatment
Operative aim is complete removal
Intramedullary tumors are characterised by
signs of slowly progressing transverse lesion
Intramedullary tumors types
- ⅔ of intramedullary tumors are ependymomas (mostly adults) or astrocytomas (mostly children),
- hemangioblastomas
- lipomas
- metastases
- or dermoid/epidermoid teratomas
- lymphomas .
most common intramedullary tumor in children
astrocytomas (mostly children),
most common intramedullary tumor in adults
ependymomas (mostly adults)
Intramedullary tumors symptoms
● Reduced pain and temperature sensation below lesion (interruption of lateral spinothalamic tract)
● Lack of radicular pain
● Tumor in conus medullaris
*Cause “saddle type” hypesthesia and autonomic disturbances
● If involving anterior horn cells: LMN involvement in corresponding muscle group
● If involving corticospinal tract: UMN weakness in muscles below lesion
intramedullary tumor
what tumor can cause saddle type hypesthesia and autonomic disturbances
● Tumor in conus medullaris
*Cause “saddle type” hypesthesia and autonomic disturbances
intramedullary tumor involving anterior horn cells causes
LMN involvement in corresponding muscle group
intramedullary tumor involving corticospinal tract causes
UMN weakness in muscles below lesion
Intramedullary tumors treatment
- Surgical (maily)
- radiotherapy (in malignant lesions such as malignant glioma
when is radiotherapy used in treatment of intramedullary tumors
in malignant lesions such as malignant glioma
