Spinal Cord Tumors - Management of Intradural Intramedullary Neoplasms Workup

Updated: Jan 14, 2016
  • Author: James S Harrop, MD; Chief Editor: Brian H Kopell, MD  more...
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Workup

Laboratory Studies

Not diagnostic of tumor pathology and reserved as part of preoperative planning

  • CBC count
  • Sequential Multiple Analysis-7
  • Prothrombin time/activated partial thromboplastin time
  • Sequential Multiple Analysis-12 (optional)
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Imaging Studies

Plain radiography

See the list below:

  • 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

See the list below:

  • 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

See the list below:

  • Nonspecific spinal canal and spinal cord widening
  • Scalloping of vertebral bodies
  • Possible intraparenchymal syringomyelia

MRI of spine with and without gadolinium

This is the criterion standard. See the images below.

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

See the list below:

  • 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 findings are as follows:

  • T1-weighted images - Isointense signal with spinal cord
  • T2-weighted images - Hyperintense signal
  • Strong homogeneous enhancement with contrast

Astrocytoma findings are as follows:

  • T1-weighted images - Isointense or hypointense signal with spinal cord
  • T2-weighted images - Hyperintense signal
  • Cyst formation
  • Heterogeneous enhancement with contrast

Hemangioblastoma findings are as follows:

  • 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.

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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.

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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.

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