Spinal Canal Flashcards

1
Q

Spinal Canal

What are the three classifications of spinal canal tumors based on their location relative to the protective layers of the cord?

A

extradural,
intradural–extramedullary,
or intramedullary

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2
Q

Spinal Canal

How many pairs of spinal nerves are there?

A

31 pairs

8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

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3
Q

Spinal Canal
Spinal cord anatomy

The gray matter is located in the periphery surrounding a central white matter.

TRUE or FALSE?

A

False.

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4
Q

Spinal Canal
Spinal cord anatomy

What horn of the gray matter controls the motor function

A

anterior horn

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5
Q

Spinal Canal
Spinal cord anatomy

What horn of the gray matter controls the autonomic functions

A

lateral horns

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6
Q

Spinal Canal
Spinal cord anatomy

What horn of the gray matter is involved with sensation

A

posterior horn

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7
Q

Spinal Canal
Spinal cord anatomy

the axons of the spinal cord are myelinated

TRUE or FALSE?

A

True

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8
Q

Spinal Canal
Spinal cord anatomy

What transmits muscle stretch and tone sensation from the extremities to the brain?

A

spinocerebellar tract

vibration

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9
Q

Spinal Canal
Spinal cord anatomy

What carries pain fibers to the brain?

A

lateral spinothalamic tract

heat and cold

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10
Q

Spinal Canal
Spinal cord anatomy

What transmits fine touch and positional sensation from the extremities to the brain

A

dorsal column

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11
Q

Spinal Canal
Spinal cord anatomy

At what level does the dural sac ends?

A

S2-3

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12
Q

Spinal Canal
Spinal cord anatomy

At what level does the dura ends?

A

coccyx

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13
Q

Spinal Canal
Spinal cord anatomy

At what level does the subarachnoid space sac ends?

A

S2-3 with the dural sac

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14
Q

Spinal Canal

Most of the primary spinal canal tumors are malignant

TRUE or FALSE?

A

False

Based on population data in the National Program of Cancer Registries (NPCR)
and Surveillance, Epidemiology, and End Results (SEER) programs from 2004
to 2007, 22% of primary spinal tumors are malignant and 78% nonmalignant
(62% benign and 16% with borderline behavior).

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15
Q

Spinal Canal

Most of the malignant spinal canal tumors occcur in males

TRUE or FALSE?

A

False

equally distributed.

Nonmalignant are more common in females.

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16
Q

Spinal Canal

What is the most common histology of spinal canal tumors?

A

Meningioma

followed by nerve sheath, ependymoma, and astrocytoma

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17
Q

Spinal Canal

What is the most common form of treatment failure of spinal canal tumors?

A

Local tumor progression

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18
Q

Spinal Canal

What is the most common presenting symptom of spinal canal tumors?

19
Q

Spinal Canal

The incidence of leptomeningeal spread in patients with primary spinal cord glioma is low overall but is substantially more common with malignant tumors.

Of note, two recently recognized entities have significantly higher risk of leptomeningeal dissemination:

what are these entities?

A

glioblastoma with primitive neuronal component

and

diffuse leptomeningeal glioneuronal tumors (DLGT).

20
Q

Spinal Canal

Differentiate the growth pattern of schwannoma and neurofibrorima in the spinal canal.

A

Neurofibromas typically encase involved nerve roots, whereas schwannomas commonly displace the nerve roots because of their assymetric growth.

NISD

21
Q

Spinal Canal

Differentiate the schwannoma and neurofibrorima in the spinal canal in terms of genetic predisposition

A

neurofibroma (nf1)

schwannoma (nf2)

22
Q

Spinal Canal
Prognostic Factors

In spinal cord astrocytomas, lower grade, younger, age, and surgical resection, and RT are predictors of better OS and cause-specific survival.

TRUE or FALSE?

A

false.

RT is predictor of worse CSS.

(Milano et al.)

23
Q

Spinal Canal
Prognostic Factors

In spinal myxopapillary ependymoma,

older age, adjuvant RT, GTR are associated with improved LC and PFS.

TRUE or FALSE?

A

True

Weber et al.

24
Q

Spinal Canal
Prognostic Factors

In the Mallinckrodt Institute of Radiology experience, Garcia reported that the primary tumor location was the most important prognostic feature.

What location is mostly associated with morbidity and worse outcomes?

25
Spinal Canal RT What is the traditional field borders for spinal canal tumors
cc: two vertebral bodies above and below laterally - tips of lateral process
26
Spinal Canal RT What is the CTV for low-grade spinal canal tumors
preop tumor volume + associated intratumoral cysts 0.5 to 1.5 cm margin. uninvolved syrinx is not necessarily included
27
Spinal Canal RT What is the standard PTV for low-grade spinal canal tumors (no OBI)
0.5 cm
28
Spinal Canal RT What is the CTV margins for high-grade spinal canal tumors
at least 1.5 cm
29
Spinal Canal RT What is the CTV for myxopapillary ependymomas of the conus?
1.5 cm cephalad and caudad but not beyond the thecal sac.
30
Spinal Canal RT When do you include the entire thecal sac in the RT volumes?
cauda equina involvement
31
Spinal Canal RT Dose prescription low-grade tumors
50.4 (1.8) Gy
32
Spinal Canal RT Dose prescription high-grade tumors
54 (1.8) Gy
33
Spinal Canal RT Dose prescription high-grade ependymomas and low-grade astrocytomas
50.4 to 54 Gy
34
Spinal Canal RT Dose prescription if CSI is needed
36 to 45 Gy CSI with boost to gross 50.4 to 54 Gy
35
Spinal Canal RT early vs. late myelitis L'Hermitte's sign
early
36
Spinal Canal RT Latency period of chronic myelopathy
13 to 29 months
37
Spinal Canal RT Chronic myelopathy has a bimodal peak. This peak corresponds to microvascular injury
late peak
38
Spinal Canal RT Chronic myelopathy has a bimodal peak. This peak corresponds to white matter injury and demyelination
early peak
39
Spinal Canal RT What is the historical maximum tolerance dose of the spinal cord?
45 to 50 Gy
40
Spinal Canal RT According to QUANTEC, a dose of ___ Gy is associated with 0.2% rate of myelopathy if given using 1.8 to 2 Gy conventional fractionation
50 Gy
41
Spinal Canal RT According to QUANTEC, a dose of ___ Gy is associated with 50% rate of myelopathy if given using 1.8 to 2 Gy conventional fractionation
69 Gy
42
Spinal Canal RT What situations are associated with lower spinal cord tolerance?
children patients receiving neurotoxic chemotherapy
43
Spinal Canal RT Bonus: What is the Gd variant used to better delineate spinal canal tumors on MRI
Gd - DTPA diethylene-triamine pentaacetic acid