Tumours of the Spinal Canal

This section is devoted to the range tumours that occur within the spinal canal . Tumours that involve the bony spinal column are usually managed by complex spinal colleagues as part of a specific multi-disciplinary team.  Most of the tumours dealt with at our practice are intradural

Classification of Spinal Canal Tumours

Spinal canal tumours may be classified into those arising from or involving the tissues outside the dural covering of the nervous system-extradural or from those arising intradurally may be subdivided into those developing within the spinal cord itself (intramedullary) or from the dura or emerging spinal nerves (intradural extramedullary-IDEM for short).

Intramedullary Spinal Cord (IMSC) Tumours

Intramedullary tumours (IMSCT) are a rare group of tumours arising within the spinal cord itself and occur in both children and adults. They are notroriously difficult to diagnose because the symptoms they produce are frequently non-specific, slowly progressive and more easily explicable by common, non-tumour pathologies.

In children they most commonly present with spinal deformity or loss of function in the extremities. In adults axial spinal or nerve pain is the most common symptom followed by altered sensation or loss of function in the extremities.Intramedullary tumours are generally named for the cell-type giving rise to them and amongst them are:

All are capable of producing signifincant and irreversible disability as they grow. Surgery for an intramedullary tumour carries significant risks but also too carries the best prospects for short and medium term control of tumours that are causing progressive disability.

The surgery serves two functions- firstly to establish the precise nature of the tumour and therefore to direct subsequent managment.

The second is the attempted cure or medium term control of the tumour. The image to the left above shows an intramedullary ependymoma of the cervical cord appearing once the cord itself has been gently opened in the midline. Some low grade intramedullary tumours (haemangioblastoma, ependymoma) may be completely cured by removal albeit sometimes at the cost of short term neurological worsening. Others which are more diffusely spread within the cord e.g. diffuse fibrillary astrocytoma may not be possible to remove completely but reducing their bulk can be enough to slow the progression of disability significantly.

Intradural Extramedullary (IDEM) Tumours

These tumours (IDEM) arise usually from the dural covering itself (Meningioma) or from the cells forming the outer sheath of the spinal nerves. Less common are benign cysts in the arachnoid layer of the meninges (arachnoid cyst) or dermoid cysts (benign growths containing cell types native to the skin). Tumours of the non functional terminal part of the spinal cord - the Filum Terminale- may also be considered in this group e.g. Myxopapillary Ependymoma. If symptomatic these tumours are usually very amenable to removal with a good safety profile

If occurring in isolation then prospects for cure are usually good. Spinal nerve sheath tumours develop in more than 40% of patients affected by Neurofibromatosis type 1 but perhaps only about 2% of those tumours cause symptoms that warrant treatment. For many patients with NF1 watchful waiting with clinical and radiological surveillence is appropriate given the propensity to develop tumours on multiple nerves over time. There is also an 8-13% lifetime risk that a patient with NF1 will develop malignant change in a previously benign nerve sheath tumour

You can read more about the various neurocutaneous conditions using the link below.