Spinal Cord Tumors
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Overview
- Primary spinal cord tumors are 10% as common as primary brain tumors but metastases to the vertebrae (the spine) are extremely common: at autopsy, the majority of patients with lung, breast, and prostate tumors have vertebral mets.
- Spinal cord tumors that grow within the spinal cord, itself, are typically gliomas, most commonly ependymomas.
- Spinal cord tumors tend to be benign (G1 or G2) and are typically treated with surgical resection.
- Ependymomas are often amenable to surgical resection: they have a clear resection plane; whereas infitrative astrocytomas often are not amenable to resection.
- Spinal cord tumors that grow outside of the spinal cord but internal to the dura mater are most commonly peripheral nerve sheath tumors (schwannomas or neurofibromas) or meningiomas and are far more common than tumors of the spinal cord, itself.
Tumor Classification by Location
Intramedullary
Grow out of the spinal cord, itself.
Most commonly:
- Ependymoma
- Ependymomas comprise ~ 50% of intramedullary spinal cord tumors.
- Astrocytoma
- Astrocytomas comprise the majority of the remaining intramedullary spinal cord tumors.
Rarely:
- Hemangioblastoma
- Metastases
- Lung
- Breast
- Melanoma
Intradural Extramedullary
Grow from internal to the dura mater but external to the spinal cord
- Peripheral nerve sheath tumors
- Meningioma
- Filum Ependymoma
Extradural Extramedullary
Grow from external to the dura mater (ie, the vertebrae)
Most commonly:
- Metastases (most common)
- Breast
- Prostate
- Lung
- GI
- Metastases (less common)
- Renal Cell
- Myeloma
- Lymphoma
- Thyroid
- Chordoma
- Sarcoma
Helpful mneomonic for key tumor metastases
- BLT with Mustard and a Kosher Pickle
- B: Breast
- L: Lung/Lymphoma
- T: Thyroid
- M: Myeloma
- K: Kidney (Renal cell)
- P: Prostate
References
- Dickman, Curtis A., and Michael G. Fehlings. Spinal Cord and Spinal Column Tumors: Principles and Practice. Thieme, 2011.
- McLendon, Roger E., Marc K. Rosenblum, and Darell D. Bigner. Russell & Rubinstein’s Pathology of Tumors of the Nervous System 7Ed. CRC Press, 2006.
- Samartzis, Dino, Christopher C. Gillis, Patrick Shih, John E. O’Toole, and Richard G. Fessler. “Intramedullary Spinal Cord Tumors: Part I—Epidemiology, Pathophysiology, and Diagnosis.” Global Spine Journal 5, no. 5 (October 2015): 425–35. https://doi.org/10.1055/s-0035-1549029.
- Tobin, Matthew K., Joseph R. Geraghty, Herbert H. Engelhard, Andreas A. Linninger, and Ankit I. Mehta. “Intramedullary Spinal Cord Tumors: A Review of Current and Future Treatment Strategies.” Neurosurgical Focus 39, no. 2 (August 2015): E14. https://doi.org/10.3171/2015.5.FOCUS15158.