eMedicine Specialties > Neurosurgery > Neoplasm

Spinal Cord Tumors - Management of Intradural Intramedullary Neoplasms: Workup

Author: James S Harrop, MD, Associate Professor, Departments of Neurological and Orthopedic Surgery, Jefferson Medical College
Coauthor(s): Ashwini D Sharan, MD, Assistant Professor of Neurosurgery, Assistant Professor of Neurology, Thomas Jefferson University School of Medicine
Contributor Information and Disclosures

Updated: May 27, 2009

Workup

Laboratory Studies

  • Not diagnostic of tumor pathology and reserved as part of preoperative planning
    • Complete blood cell count
    • Sequential Multiple Analysis-7
    • Prothrombin time/activated partial thromboplastin time
    • Sequential Multiple Analysis-12 (optional)

Imaging Studies

  • Plain radiography
    • Not accurate for diagnosis
    • Abnormalities identified in 20% of patients
    • Scalloping of the vertebral bodies on lateral radiographs
    • Widening of interpedicular distance on anteroposterior radiographs
    • Scoliosis in children that results from neuromuscular impairment
  • Myelography
    • Not optimal because it is invasive and can alter spinal fluid dynamics, causing neurologic worsening
    • Nonspecific spinal canal and spinal cord widening
    • Multisegmental involvement
    • Block of contrast dye
    • Conus region lesions, possible meniscus around the tumor
  • CT scan
    • Nonspecific spinal canal and spinal cord widening
    • Scalloping of vertebral bodies
    • Possible intraparenchymal syringomyelia
  • MRI of spine with and without gadolinium (criterion standard, see Images 1-2)


This T1-weighted sagittal MRI is from a 19-year-o...

This T1-weighted sagittal MRI is from a 19-year-old man with 4-month history of progressive motor loss and an inability to ambulate. He underwent spinal biopsy that confirmed an intramedullary glioblastoma.

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This T1-weighted sagittal MRI is from a 19-year-o...

This T1-weighted sagittal MRI is from a 19-year-old man with 4-month history of progressive motor loss and an inability to ambulate. He underwent spinal biopsy that confirmed an intramedullary glioblastoma.



This T2-weighted MRI is from a 19-year-old man wi...

This T2-weighted MRI is from a 19-year-old man with 4-month history of progressive motor loss and an inability to ambulate. He underwent spinal biopsy that confirmed an intramedullary glioblastoma.

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This T2-weighted MRI is from a 19-year-old man wi...

This T2-weighted MRI is from a 19-year-old man with 4-month history of progressive motor loss and an inability to ambulate. He underwent spinal biopsy that confirmed an intramedullary glioblastoma.

    • Most accurate and noninvasive technique
    • Gadolinium (contrast) requires evaluation of kidney function because cases of malignant fibrosis reported
    • Enlargement of the spinal cord
    • Syringomyelia or cystic cavity associated within the lesion
    • Ependymoma
      • T1-weighted images - Isointense signal with spinal cord
      • T2-weighted images - Hyperintense signal
      • Strong homogeneous enhancement with contrast
    • Astrocytoma
      • T1-weighted images - Isointense or hypointense signal with spinal cord
      • T2-weighted images - Hyperintense signal
      • Cyst formation
      • Heterogeneous enhancement with contrast
    • Hemangioblastoma
      • T1-weighted images - Isointense signal to spinal cord
      • T2-weighted images - Hyperintense signal
      • Cystic with tumor nodule (50-70%)
      • Enhances strongly with contrast
      • Extramedullary extension in 15%
  • Spinal arteriography: This is beneficial only if a hemangioblastoma is suggested as a differential diagnosis. Hemangioblastoma arteriography findings include a vascular blush with a prominent draining vein.

Other Tests

  • Baseline urodynamics: Findings may assist in diagnosing abnormal bladder function.
  • Neurophysiologic testing (EMG/NCS/SSEP): Findings may quantify degree of neurologic injury from tumor

Diagnostic Procedures

  • Lumbar puncture is not indicated unless the patient is being evaluated for drop metastasis or leptomeningeal spread of intracranial disease (as in cranial ependymomas). In addition, lumbar puncture may be useful to differentiate if due to infectious or inflammatory myelitis (multiple sclerosis). However, clinical presentation and imaging studies can typically exclude these etiologies.
  • Neurological deterioration can be precipitated after lumbar puncture if a complete myelographic block is present from changes in the compliance of the lesion and position of the neoplasm.

More on Spinal Cord Tumors - Management of Intradural Intramedullary Neoplasms

Overview: Spinal Cord Tumors - Management of Intradural Intramedullary Neoplasms
Workup: Spinal Cord Tumors - Management of Intradural Intramedullary Neoplasms
Treatment: Spinal Cord Tumors - Management of Intradural Intramedullary Neoplasms
Follow-up: Spinal Cord Tumors - Management of Intradural Intramedullary Neoplasms
Multimedia: Spinal Cord Tumors - Management of Intradural Intramedullary Neoplasms
References
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References

  1. Brotchi J. Intrinsic spinal cord tumor resection. Neurosurgery. May 2002;50(5):1059-63. [Medline].

  2. Burger PC, Scheithauer BW. Tumors of the central nervous system. In: Rosai J, Sobin LH, eds. Atlas of Tumor Pathology. 3rd series, fasc 10. Washington, DC: Armed Forces Institute of Pathology; 1994.

  3. Casha S, Phan N, Rutka JT. Spinal Cord and Column Tumors in Children. Spinal Cord and Spinal Column Tumors - Thieme. 2006;1:187-203.

  4. Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ. Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg. Oct 2000;93(2 Suppl):183-93. [Medline].

  5. Cooper PR, Hida K. Intramedullary Spinal Cord Tumors. Spinal Cord and Spinal Column Tumors - Thieme. 2006;315-334.

  6. Epstein FJ, Farmer JP, Freed D. Adult intramedullary astrocytomas of the spinal cord. J Neurosurg. Sep 1992;77(3):355-9. [Medline].

  7. Kane PJ, el-Mahdy W, Singh A, Powell MP, Crockard HA. Spinal intradural tumours: Part II--Intramedullary. Br J Neurosurg. Dec 1999;13(6):558-63. [Medline].

  8. Mechtler L, Cohen ME. Clinical presentation and therapy of spinal tumors. In: Bradley, WG, Daroff RB, Fenchel GM, Marsden CD. Neurology in Clinical Practice: The Neurological Disorders. 2nd ed. Boston, Mass: Butterworth-Heinemann; 1996.

  9. Osborn AG. Diagnostic Neuroradiology. St. Louis, Mo: Mosby-Year Book; 1994.

  10. Parsa AT, Lee J, Parney IF, Weinstein P, McCormick PC, Ames C. Spinal cord and intradural-extraparenchymal spinal tumors: current best care practices and strategies. J Neurooncol. Aug-Sep 2004;69(1-3):291-318. [Medline].

  11. Sahni D, Harrop JS, Kalfas IH, Vaccaro AR, Weingarten D. Exophytic intramedullary meningioma of the cervical spinal cord. J Clin Neurosci. Oct 2008;15(10):1176-9. [Medline].

  12. Saraceni C, Harrop JS. Spinal meningioma: chronicles of contemporary neurosurgical diagnosis and management. Clin Neurol Neurosurg. Apr 2009;111(3):221-6. [Medline].

  13. Simeone FA. Intradural tumors. In: Rothman RH, Simeone FA, eds. The Spine. 3rd ed. Philadelphia, Pa: WB Saunders; 1992.

  14. Slin'ko EI, Al-Qashqish II. Intradural ventral and ventrolateral tumors of the spinal cord: surgical treatment and results. Neurosurg Focus. Jul 15 2004;17(1):ECP2. [Medline].

  15. Manzano G, Green BA, Vanni S, Levi AD. Contemporary management of adult intramedullary spinal tumors-pathology and neurological outcomes related to surgical resection. Spinal Cord. Aug 2008;46(8):540-6. [Medline].

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Further Reading

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Keywords

spinal cord tumors, spinal tumors, spinal cord neoplasms, spinal neoplasms, intramedullary spinal cord tumor, intradural neoplasms, intradural tumors, intramedullary neoplasms, spine tumors, glial cell neoplasms, glial cell tumors, astrocytomas, ependymomas, hemangioblastomas, paragangliomas, oligodendrogliomas, gangliogliomas, schwannomas, meningiomas, neurofibromas, intradural intramedullary neoplasms

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Contributor Information and Disclosures

Author

James S Harrop, MD, Associate Professor, Departments of Neurological and Orthopedic Surgery, Jefferson Medical College
James S Harrop, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Spinal Injury Association, Cervical Spine Research Society, Congress of Neurological Surgeons, and North American Spine Society
Disclosure: Depuy spine Consulting fee Consulting; Medtronic Consulting fee Consulting; stryker spine Honoraria Speaking and teaching

Coauthor(s)

Ashwini D Sharan, MD, Assistant Professor of Neurosurgery, Assistant Professor of Neurology, Thomas Jefferson University School of Medicine
Ashwini D Sharan, MD is a member of the following medical societies: American Medical Association, Association for the Advancement of Medical Instrumentation, Congress of Neurological Surgeons, and Movement Disorders Society
Disclosure: Nothing to disclose.

Medical Editor

Scott C Dulebohn, MD, Neurological Surgeon, Appalachian Neurosurgical
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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