Spine Neoplasia

Question 1

What are the most common intramedullary spine tumors?

Answer 1

Ependymoma (45%)
Astrocytoma (35%)
Hemangioblastoma (5%)
Others: Lipoma, Ganglioglioma

Question 2

Spinal ependymoma: at what age do they peak?

Answer 2

Young adults

Question 3

Spinal ependymoma: associated with what syndrome?

Answer 3

Neurofibromatosis 2

Question 4

Spinal ependymoma: Natural history

Answer 4

Months to years of nocturnal pain, then sensory/motor loss, sphincter disturbance
Can also get central cord symptoms from syrinx formation

Question 5

Spinal ependymoma: Prognosis

Answer 5

Good and recurrence low if complete resection is achieved

Question 6

Spinal ependymoma: Treatment

Answer 6

Complete surgical resection

Adjuvant radiation if high grade or multiple recurrent lesions

Question 7

Spinal ependymoma: Most important predictor of postop function

Answer 7

preop status

Question 8

Spinal astrocytoma: what age group

Answer 8

90% in age

Question 9

Spinal ependymoma: where are they most commonly located?

Answer 9

Cervical and filum (typically myxopapillary ependymoma)

Question 10

Spinal astrocytoma: where are they most commonly located?

Answer 10

Thoracic and cervical

Question 11

Spinal astrocytoma: Presentation/Natural history

Answer 11

Indistinguishable from ependymoma. 25% malignant in adult

Question 12

Spinal astrocytoma: 5 year survival

Answer 12

50% for 5 year survival (low grade) - recurrences common

Question 13

Spinal astrocytoma: Treatment

Answer 13

Surgical resection

Adjuvant radiation for multiple recurrent lesions

Question 14

Spinal hemangioblastoma: what percent of spinal intramedullary tumors?

Answer 14

5%

Question 15

Spinal hemangioblastoma: associated with what syndrome

Answer 15

Von Hippel Linda (in 1/3)

Question 16

Spinal hemangioblastoma: What age of presentation

Answer 16

Mean age 30-40

Question 17

Spinal hemangioblastoma: Most common location

Answer 17

Thoracic or cervical

Question 18

Spinal hemangioblastoma: Most common presentation

Answer 18

Years of sensory deficit (proprioceptive pain 2/2 dorsal columns), then sensory/motor loss, sphincter

Question 19

Spinal hemangioblastoma: Prognosis

Answer 19

Good and recurrence low if complete resection is achieved

Question 20

Spinal hemangioblastoma: Treatment

Answer 20

Complete surgical resection

Question 21

Ganglioglioma: Prognosis

Answer 21

Slow progression. Treat like ependymoma

Question 22

What are the most common intradural extramedullary spinal tumors?

Answer 22

Meningioma (40%)
Schwannoma (30%)
Neurofibroma (10%)

Question 23

Spinal meningioma: peak age of onset

Answer 23

age 50, more common in women

Question 24

Spinal meningioma: multiple is associated with what syndrome

Answer 24

Neurofibromatosis 2

Question 25

Spinal meningioma: Presentation

Answer 25

Localized back pain or slow-onset myelopathy

Question 26

Spinal meningioma: Recurrence rate

Answer 26

5%

15% with subtotal resection (better than cranial prognosis)

Question 27

Spinal meningioma: Treatment

Answer 27

Total surgical excision

Radiotherapy for recurrences that cannot be completely excised or rare malignant forms

Question 28

Spinal schwannoma: peak age

Answer 28

30 years

Question 29

Spinal schwannoma: associated with what syndrome

Answer 29

Neurofibromatosis 2

Question 30

Spinal schwannoma: Presentation

Answer 30

80% with radicular pain

Question 31

Spinal schwannoma: Recurrence rate

Answer 31

5-10%

40% in NF2

Question 32

Spinal schwannoma: Treatment

Answer 32

Total surgical excision

Question 33

Spinal neurofibroma: sex predilection

Answer 33

None

Question 34

Spinal neurofibroma: Peak age of onset

Answer 34

age 20

Question 35

Spinal neurofibroma: what syndrome is it associated with

Answer 35

Neurofibromatosis 1 (60% with NF)

Question 36

Spinal neurofibroma: Presentation

Answer 36

80% with radicular pain

Question 37

Spinal neurofibroma: Recurrence rate

Answer 37

10-15% (malignant degeneration 5-10% in NF1)

Question 38

Spinal neurofibroma: Treatment

Answer 38

Total excision. Pain relief (85%) even with partial excision