Elsevier

The Lancet Oncology

Volume 8, Issue 1, January 2007, Pages 35-45
The Lancet Oncology

Review
Part I: Spinal-cord neoplasms—intradural neoplasms

https://doi.org/10.1016/S1470-2045(06)71009-9Get rights and content

Summary

Intradural spinal-cord tumours are an uncommon but important consideration in the differential diagnosis of patients with back pain, radicular pain, sensorimotor deficits, or sphincter dysfunction. Intradural spinal tumours can be divided into intramedullary and extramedullary spinal-cord tumours on the basis of their anatomical relation to the spinal parenchyma. The heterogeneous cell composition of the intradural compartment allows the formation of neoplasms, arising from glial cells, neurons, and cells of spinal vasculature. Additionally, developmental tumours, metastases, and intradural extension of extradural tumours are represented. In this Review, we discuss the published work on intradural spinal-cord tumours in terms of epidemiological, radiographic, and histological characteristics. Surgical and adjuvant treatment strategies are also reviewed.

Introduction

Spinal-cord neoplasms (SCNs; figure 1) are an uncommon cause of back pain, radicular pain, and sensorimotor deficits in both adult and paediatric patients. SCNs can be divided into extradural and intradural tumours on the basis of their relation to the thecal sac that surrounds the spinal cord and cauda equina. Extradural tumours, located outside the thecal sac, account for almost 60% of SCNs. About 30% of tumours are contained within the thecal sac and are, therefore, intradural neoplasms. Concomitant intradural and extradural components are associated with roughly 10% of SCNs. Within the intradural compartment, tumours can originate adjacent to (extramedullary) or within (intramedullary) the spinal-cord parenchyma. In view of the heterogeneous cell composition within the intradural compartment, the histogenesis of neoplasms located at this site is varied (panel). Differentiation and diagnosis of intramedullary spinal-cord tumours (IMSCTs) and extramedullary spinal-cord tumours (EMSCTs) are widely achievable through clinical examination and radiographic techniques. MRI is the preferred method of radiographic assessment of intradural spinal tumours and can suggest histological subtype. Other radiographic examinations, such as CT and myelogram, are useful if MRI is contraindicated. Magnetic resonance angiogram (MRA) or spinal arteriogram can be beneficial if the tumour has a vascular component. Histological examination of the tumour after biopsy or surgical resection is able to establish the histogenesis of intradural tumours in almost all cases.

Section snippets

Extramedullary tumours

EMSCTs account for more than 70% of intradural spinal-cord tumours in adults and are only slightly less common in children. The most common primary EMSCTs are derived from sheath cells covering the spinal-nerve roots (schwannomas and neurofibromas) or meningial cells located along the spinal-cord surface (meningiomas). Myxopapillary ependymomas are extramedullary tumours arising from the conus medullaris and filum terminalis. Other tumour types, such as hemangiopericytomas, lipomas,

Intramedullary tumours

IMSCTs account for 20–30% of intradural tumours in adults, and up to 50% of intradural tumours in children.27, 28 Glial tumours, such as astrocytomas and ependymomas, represent up to 80% of IMSCTs, with a paediatric predominance of astrocytomas and an adult predominance of ependymomas. Oligodendrogliomas, mixed gliomas, neuron-derived tumours, gangliogliomas, hemangioblastomas, lipomas, and developmental tumours are uncommon. Finally, metastatic intramedullary spinal-cord tumours account for

Conclusion

Although uncommon, intradural spinal-cord tumours should be an important consideration in the differential diagnosis of the adult or paediatric patient presenting with back or radicular pain associated with neurological deficits. The heterogeneous cell composition within the intradural compartment allows the presence of a histologically variable group of neoplasms. Radiographic assessment combined with histological examination helps with the identification of the histogenesis of these tumours,

Search strategy and selection criteria

Data for this review were identified by searches of MEDLINE, PubMed, and references from relevant articles using the following search terms: “spinal”, “intradural”, “intramedullary”, “extramedullary”, “schwannoma”, “neurofibroma”, “myxopapillary ependymoma” “epidermoid”, “dermoid”, “hemangiopericytoma”, “lipoma”, “meningioma”, “paraganglioma”, “metastasis”, “astrocytoma”, “ependymoma”, “ganglioglioma”, “hemangioblastoma”, “lipoma”, “neuroblastoma”, “neurofibroma”, “oligodendroglioma”,

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