Tumors of the spinal cord

Tumors of the spinal cord account for 15% of all CNS tumors. Isolated extra- and intramedullary tumors. Extramedullary tumors can be located under the dura mater and above it. Extradural tumors are usually malignant (metastasis). Among subdural tumors, 70% are extramedullary and 30% are intramedullary. The most common subdural extramedullary tumors are neurinomas (30%) and meningiomas (25%). A typical picture of an extramedullary tumor consists of three stages: the stage of radicular pain, the stage of partial compression of the spinal cord (often in the form of the Brown-Sekar syndrome) and the stage of complete transverse compression of the spinal cord. Following root pain at the tumor level (most often such pains are observed with neurinomas and metastatic tumors), para- or tetraparesis, sensitivity loss and pelvic disorders gradually increase. Intramedullary tumors are most often gliomas; In the region of the cone and the ponytail, ependymomas are not uncommon. In contrast to extramedullary tumors, in which the sensory and motor disorders increase from the bottom up, intramedullary development is characterized by the development of spinal symptoms from the top down.

Contrary to the prevailing view, the actual clinical syndrome is usually unreliable for the differential diagnosis of extra- and intramedullary tumors. It is much easier to determine the level of the location of the tumor. However, in this respect the diagnosis becomes absolutely reliable if spondylography either reveals an expansion of the intervertebral foramen (the result of extra-spinal neurinoma growth of the "hourglass" type), or reveals a local increase in the sagittal diameter of the spinal canal due to destruction of the roots of the arch or destruction of the vertebrae in metastatic tumors. The study of cerebrospinal fluid confirms the fact of compression of the spinal cord in case of detection of protein-cell dissociation (a sharp increase in protein under normal cytosis) and blockade of the subarachnoid space in the Quéquenstedt test. A decisive role in preoperative diagnosis is played by computed tomography and (or) myelography. Myelography with a water-soluble contrast agent is mandatory for all cases when it is possible to assume the compression genesis of the spinal syndrome. The picture of a tumor of the spinal cord can mimic many spinal processes, most often the hernia of intervertebral discs and spinal forms of multiple sclerosis. Unlike all other spinal cord tumors, in which the formation of spinal lesions lasts for months and years, extradural metastases can cause the development of transverse brain damage within a few hours. Such a sharp development invariably gives rise to the assumption of the presence of a spinal stroke. Often the cause of compression of the spinal cord can be blastomatous and inflammatory lesions of the spine.

Treatment is surgical. In contrast to extramedullary tumors, intramedullary can be removed in most cases at the cost of irreversible severe brain damage. Therefore, in the vast majority of patients with intraspinal gliomas, the operation is limited to a decompressive laminectomy followed by radiotherapy.

Forecast. Timely removal of neurin and meningitis leads in most cases to recovery.