Spine Neoplasia Flashcards
What are the most common intramedullary spine tumors?
Ependymoma (45%)
Astrocytoma (35%)
Hemangioblastoma (5%)
Others: Lipoma, Ganglioglioma
Spinal ependymoma: at what age do they peak?
Young adults
Spinal ependymoma: associated with what syndrome?
Neurofibromatosis 2
Spinal ependymoma: Natural history
Months to years of nocturnal pain, then sensory/motor loss, sphincter disturbance
Can also get central cord symptoms from syrinx formation
Spinal ependymoma: Prognosis
Good and recurrence low if complete resection is achieved
Spinal ependymoma: Treatment
Complete surgical resection
Adjuvant radiation if high grade or multiple recurrent lesions
Spinal ependymoma: Most important predictor of postop function
preop status
Spinal astrocytoma: what age group
90% in age
Spinal ependymoma: where are they most commonly located?
Cervical and filum (typically myxopapillary ependymoma)
Spinal astrocytoma: where are they most commonly located?
Thoracic and cervical
Spinal astrocytoma: Presentation/Natural history
Indistinguishable from ependymoma. 25% malignant in adult
Spinal astrocytoma: 5 year survival
50% for 5 year survival (low grade) - recurrences common
Spinal astrocytoma: Treatment
Surgical resection
Adjuvant radiation for multiple recurrent lesions
Spinal hemangioblastoma: what percent of spinal intramedullary tumors?
5%
Spinal hemangioblastoma: associated with what syndrome
Von Hippel Linda (in 1/3)
Spinal hemangioblastoma: What age of presentation
Mean age 30-40
Spinal hemangioblastoma: Most common location
Thoracic or cervical
Spinal hemangioblastoma: Most common presentation
Years of sensory deficit (proprioceptive pain 2/2 dorsal columns), then sensory/motor loss, sphincter
Spinal hemangioblastoma: Prognosis
Good and recurrence low if complete resection is achieved
Spinal hemangioblastoma: Treatment
Complete surgical resection
Ganglioglioma: Prognosis
Slow progression. Treat like ependymoma
What are the most common intradural extramedullary spinal tumors?
Meningioma (40%)
Schwannoma (30%)
Neurofibroma (10%)
Spinal meningioma: peak age of onset
age 50, more common in women
Spinal meningioma: multiple is associated with what syndrome
Neurofibromatosis 2
Spinal meningioma: Presentation
Localized back pain or slow-onset myelopathy
Spinal meningioma: Recurrence rate
5%
15% with subtotal resection (better than cranial prognosis)
Spinal meningioma: Treatment
Total surgical excision
Radiotherapy for recurrences that cannot be completely excised or rare malignant forms
Spinal schwannoma: peak age
30 years
Spinal schwannoma: associated with what syndrome
Neurofibromatosis 2
Spinal schwannoma: Presentation
80% with radicular pain
Spinal schwannoma: Recurrence rate
5-10%
40% in NF2
Spinal schwannoma: Treatment
Total surgical excision
Spinal neurofibroma: sex predilection
None
Spinal neurofibroma: Peak age of onset
age 20
Spinal neurofibroma: what syndrome is it associated with
Neurofibromatosis 1 (60% with NF)
Spinal neurofibroma: Presentation
80% with radicular pain
Spinal neurofibroma: Recurrence rate
10-15% (malignant degeneration 5-10% in NF1)
Spinal neurofibroma: Treatment
Total excision. Pain relief (85%) even with partial excision
