Skip to main content

Advertisement

SpringerLink
Log in

Intradural spinal tumors in adults—update on management and outcome

  • Review
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Among spinal tumors that occur intradurally, meningiomas, nerve sheath tumors, ependymomas, and astrocytomas are the most common. While a spinal MRI is the state of the art to diagnose intradural spinal tumors, in some cases CT scans, angiography, CSF analyses, and neurophysiological examination can be valuable. The management of these lesions depends not only on the histopathological diagnosis but also on the clinical presentation and the anatomical location, allowing either radical resection as with most extramedullary lesions or less invasive strategies as with intramedullary lesions. Although intramedullary lesions are rare and sometimes difficult to manage, well-planned treatment can achieve excellent outcome without treatment-related deficits. Technical advances in imaging, neuromonitoring, minimally invasive approaches, and radiotherapy have improved the outcome of intradural spinal tumors. However, the outcome in malignant intramedullary tumors remains poor. While surgery is the mainstay treatment for many of these lesions, radiation and chemotherapy are of growing importance in recurrent and multilocular disease. We reviewed the literature on this topic to provide an overview of spinal cord tumors, treatment strategies, and outcomes. Typical cases of extra- and intramedullary tumors are presented to illustrate management options and outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Van Goethem JW, van den Hauwe L, Ozsarlak O, De Schepper AM, Parizel PM (2004) Spinal tumors. Eur J Radiol 50:159–176. https://doi.org/10.1016/j.ejrad.2003.10.021

    Article  PubMed  Google Scholar 

  2. Youmans JR, Winn HR Youmans neurological surgery. Saunders, City

  3. Tonn J-C, Grossman SA, Rutka JT, Westphal M (2006) Neuro-oncology of CNS tumors. Springer, Berlin Heidelberg, City

    Book  Google Scholar 

  4. McCormick PC, Torres R, Post KD, Stein BM (1990) Intramedullary ependymoma of the spinal cord. J Neurosurg 72:523–532. https://doi.org/10.3171/jns.1990.72.4.0523

    Article  CAS  PubMed  Google Scholar 

  5. Klekamp J, Samii M (1993) Introduction of a score system for the clinical evaluation of patients with spinal processes. Acta Neurochir 123:221–223

    CAS  PubMed  Google Scholar 

  6. Frankel HL, Hancock DO, Hyslop G et al (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I Paraplegia 7:179–192. https://doi.org/10.1038/sc.1969.30

    Article  CAS  PubMed  Google Scholar 

  7. dos Santos MP, Zhang J, Ghinda D et al (2015) Imaging diagnosis and the role of endovascular embolization treatment for vascular intraspinal tumors. Neurosurg Focus 39:E16. https://doi.org/10.3171/2015.5.FOCUS1514

    Article  PubMed  Google Scholar 

  8. Rubinstein LJ, Hartmann WH, Institute of Pathology (1972) Atlas of tumor pathology Ser. 2 Fasc. 6 @Tumors of the central nervous system [Hauptbd.]. [s.N.], City

  9. Cohen-Gadol AA, Zikel OM, Koch CA, Scheithauer BW, Krauss WE (2003) Spinal meningiomas in patients younger than 50 years of age: a 21-year experience. J Neurosurg 98:258–263

    PubMed  Google Scholar 

  10. Yoon SH, Chung CK, Jahng TA (2007) Surgical outcome of spinal canal meningiomas. J Korean Neurosurg Soc 42:300–304. https://doi.org/10.3340/jkns.2007.42.4.300

    Article  PubMed  PubMed Central  Google Scholar 

  11. Setzer M, Vatter H, Marquardt G, Seifert V, Vrionis FD (2007) Management of spinal meningiomas: surgical results and a review of the literature. Neurosurg Focus 23:E14. https://doi.org/10.3171/FOC-07/10/E14

    Article  PubMed  Google Scholar 

  12. Sacko O, Rabarijaona M, Loiseau H (2008) Spinal meningioma surgery after 75 years of age. Neurochirurgie 54:512–516. https://doi.org/10.1016/j.neuchi.2008.02.059

    Article  CAS  PubMed  Google Scholar 

  13. Iacoangeli M, Gladi M, Di Rienzo A et al (2012) Minimally invasive surgery for benign intradural extramedullary spinal meningiomas: experience of a single institution in a cohort of elderly patients and review of the literature. Clin Interv Aging 7:557–564. https://doi.org/10.2147/CIA.S38923

    Article  PubMed  PubMed Central  Google Scholar 

  14. Muroi C, Fandino J, Coluccia D, Berkmann S, Fathi AR, Landolt H (2013) 5-Aminolevulinic acid fluorescence-guided surgery for spinal meningioma. World neurosurgery 80(223):e221–e223. https://doi.org/10.1016/j.wneu.2012.12.017

    Article  Google Scholar 

  15. Kufeld M, Wowra B, Muacevic A, Zausinger S, Tonn JC (2012) Radiosurgery of spinal meningiomas and schwannomas. Technol Cancer Res Treat 11:27–34

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Gottfried ON, Gluf W, Quinones-Hinojosa A, Kan P, Schmidt MH (2003) Spinal meningiomas: surgical management and outcome. Neurosurg Focus 14:e2

    Article  PubMed  Google Scholar 

  17. King AT, Sharr MM, Gullan RW, Bartlett JR (1998) Spinal meningiomas: a 20-year review. Br J Neurosurg 12:521–526

    Article  CAS  PubMed  Google Scholar 

  18. Klekamp J, Samii M (1999) Surgical results for spinal meningiomas. Surg Neurol 52:552–562

    Article  CAS  PubMed  Google Scholar 

  19. Levy WJ Jr, Bay J, Dohn D (1982) Spinal cord meningioma. J Neurosurg 57:804–812. https://doi.org/10.3171/jns.1982.57.6.0804

    Article  PubMed  Google Scholar 

  20. Roux FX, Nataf F, Pinaudeau M, Borne G, Devaux B, Meder JF (1996) Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol 46:458–463 discussion 463-454

    Article  CAS  PubMed  Google Scholar 

  21. Sandalcioglu IE, Hunold A, Muller O, Bassiouni H, Stolke D, Asgari S (2008) Spinal meningiomas: critical review of 131 surgically treated patients. Eur Spine J : Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Section Cervical Spine Res Soc 17:1035–1041. https://doi.org/10.1007/s00586-008-0685-y

    Article  Google Scholar 

  22. Solero CL, Fornari M, Giombini S et al (1989) Spinal meningiomas: review of 174 operated cases. Neurosurgery 25:153–160

    Article  CAS  PubMed  Google Scholar 

  23. Schaller B (2005) Spinal meningioma: relationship between histological subtypes and surgical outcome? J Neuro-Oncol 75:157–161. https://doi.org/10.1007/s11060-005-1469-4

    Article  Google Scholar 

  24. Riad H, Knafo S, Segnarbieux F, Lonjon N (2013) Spinal meningiomas: surgical outcome and literature review. Neurochirurgie 59:30–34. https://doi.org/10.1016/j.neuchi.2012.10.137

    Article  CAS  PubMed  Google Scholar 

  25. Haegelen C, Morandi X, Riffaud L, Amlashi SF, Leray E, Brassier G (2005) Results of spinal meningioma surgery in patients with severe preoperative neurological deficits. Eur Spine J : Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Section of the Cervical Spine Res Soc 14:440–444. https://doi.org/10.1007/s00586-004-0809-y

    Article  CAS  Google Scholar 

  26. Ozawa H, Kokubun S, Aizawa T, Hoshikawa T, Kawahara C (2007) Spinal dumbbell tumors: an analysis of a series of 118 cases. J Neurosurg Spine 7:587–593. https://doi.org/10.3171/SPI-07/12/587

    Article  PubMed  Google Scholar 

  27. Nanda A, Kukreja S, Ambekar S, Bollam P, Sin AH (2015) Surgical strategies in the management of spinal nerve sheath tumors. World Neurosurg 83:886–899. https://doi.org/10.1016/j.wneu.2015.01.020

    Article  PubMed  Google Scholar 

  28. Raysi Dehcordi S, Marzi S, Ricci A, Di Cola F, Galzio RJ (2012) Less invasive approaches for the treatment of cervical schwannomas: our experience. Eur Spine J : Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Section of the Cervical Spine Res Soc 21:887–896. https://doi.org/10.1007/s00586-011-2118-6

    Article  CAS  Google Scholar 

  29. Sachdev S, Dodd RL, Chang SD et al (2011) Stereotactic radiosurgery yields long-term control for benign intradural, extramedullary spinal tumors. Neurosurgery 69:533–539; discussion 539. https://doi.org/10.1227/NEU.0b013e318218db23

    Article  PubMed  Google Scholar 

  30. Lee SE, Chung CK, Kim HJ (2013) Intramedullary schwannomas: long-term outcomes of ten operated cases. J Neuro-Oncol 113:75–81. https://doi.org/10.1007/s11060-013-1091-9

    Article  Google Scholar 

  31. Fernandes RL, Lynch JC, Welling L et al (2014) Complete removal of the spinal nerve sheath tumors. Surgical techniques and results from a series of 30 patients. Arq Neuropsiquiatr 72:312–317

    Article  PubMed  Google Scholar 

  32. Lenzi J, Anichini G, Landi A et al (2017) spinal nerves schwannomas: experience on 367 cases-historic overview on how clinical, radiological, and surgical practices have changed over a course of 60 years. Neurol Res Int 2017(1):3568359–3568312. https://doi.org/10.1155/2017/3568359

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sonneland PR, Scheithauer BW, Onofrio BM (1985) Myxopapillary ependymoma. A clinicopathologic and immunocytochemical study of 77 cases. Cancer 56:883–893

    Article  CAS  PubMed  Google Scholar 

  34. Klekamp J (2015) Spinal ependymomas. Part 2: Ependymomas of the filum terminale. Neurosurgical Focus 39:E7. https://doi.org/10.3171/2015.5.FOCUS15151

    Article  PubMed  Google Scholar 

  35. Nakamura M, Ishii K, Watanabe K et al (2009) Long-term surgical outcomes for myxopapillary ependymomas of the cauda equina. Spine 34:E756–E760. https://doi.org/10.1097/BRS.0b013e3181b34d16

    Article  PubMed  Google Scholar 

  36. Hallacq P, Labrousse F, Streichenberger N, Lisii D, Fischer G (2003) Bifocal myxopapillary ependymoma of the terminal filum: the end of a spectrum? Case report. J Neurosurg 98:288–289

    PubMed  Google Scholar 

  37. Qian X, Goumnerova LC, De Girolami U, Cibas ES (2008) Cerebrospinal fluid cytology in patients with ependymoma: a bi-institutional retrospective study. Cancer 114:307–314. https://doi.org/10.1002/cncr.23799

    Article  PubMed  Google Scholar 

  38. de Jong L, Calenbergh FV, Menten J et al (2012) Ependymomas of the filum terminale: the role of surgery and radiotherapy. Surg Neurol Int 3:76. https://doi.org/10.4103/2152-7806.98509

    Article  PubMed  PubMed Central  Google Scholar 

  39. Weber DC, Wang Y, Miller R et al (2015) Long-term outcome of patients with spinal myxopapillary ependymoma: treatment results from the MD Anderson Cancer Center and institutions from the Rare Cancer Network. Neuro-Oncology 17:588–595. https://doi.org/10.1093/neuonc/nou293

    Article  PubMed  Google Scholar 

  40. Wostrack M, Pape H, Kreutzer J, Ringel F, Meyer B, Stoffel M (2012) Surgical treatment of spinal intradural carcinoma metastases. Acta Neurochir 154:349–357. https://doi.org/10.1007/s00701-011-1204-1

    Article  PubMed  Google Scholar 

  41. Reina MA, Lopez-Garcia A, Dittmann M, de Andres JA, Blazquez MG (1996) Iatrogenic spinal epidermoid tumors. A late complication of spinal puncture. Revista espanola de anestesiologia y reanimacion 43:142–146

    CAS  PubMed  Google Scholar 

  42. Barbagallo GMV, Maione M, Raudino G, Certo F (2017) Thoracic intradural-extramedullary epidermoid tumor: the relevance for resection of classic subarachnoid space microsurgical anatomy in modern spinal surgery. Technical note and review of the literature. World Neurosurg 108:54–61. https://doi.org/10.1016/j.wneu.2017.08.078

    Article  PubMed  Google Scholar 

  43. Morita M, Miyauchi A, Okuda S, Oda T, Aono H, Iwasaki M (2012) Intraspinal epidermoid tumor of the cauda equina region: seven cases and a review of the literature. J Spinal Disord Tech 25:292–298. https://doi.org/10.1097/BSD.0b013e31821e2464

    Article  PubMed  Google Scholar 

  44. Dobre MC, Smoker WR, Moritani T, Kirby P (2012) Spontaneously ruptured intraspinal epidermoid cyst causing chemical meningitis. J Clin Neurosc : Off J Neurosurg Soc Australas 19:587–589. https://doi.org/10.1016/j.jocn.2011.09.006

    Article  Google Scholar 

  45. van Aalst J, Hoekstra F, Beuls EA et al (2009) Intraspinal dermoid and epidermoid tumors: report of 18 cases and reappraisal of the literature. Pediatr Neurosurg 45:281–290. https://doi.org/10.1159/000235602

    Article  PubMed  Google Scholar 

  46. Pang D (2015) Total resection of complex spinal cord lipomas: how, why, and when to operate? Neurol Med Chir 55:695–721. https://doi.org/10.2176/nmc.ra.2014-0442

    Article  Google Scholar 

  47. Wan W, Yang C, Yan W et al (2017) Adult-onset intradural spinal teratoma: report of 18 consecutive cases and outcomes in a single center. Eur Spine J : Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Section Cervical Spine Res Soc 26:1917–1928. https://doi.org/10.1007/s00586-016-4939-9

    Article  Google Scholar 

  48. Chen CT, Lee CY, Lee ST, Chang CN, Wei KC, Wu CT (2016) Neurenteric cysts: risk factors and management of recurrence. Acta Neurochir 158:1325–1331. https://doi.org/10.1007/s00701-016-2828-y

    Article  PubMed  Google Scholar 

  49. Hong B, Nakamura M, Hartmann C, Brandis A, Ganser A, Krauss JK (2013) Delayed distant spinal metastasis in thymomas. Spine 38:E1709–E1713. https://doi.org/10.1097/BRS.0000000000000029

    Article  PubMed  Google Scholar 

  50. Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G (2005) Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery 56:972–981 discussion 972-981

    PubMed  Google Scholar 

  51. Bansal S, Ailawadhi P, Suri A et al (2013) Ten years’ experience in the management of spinal intramedullary tumors in a single institution. J Clin Neurosci : Off J Neurosurg Soc Australas 20:292–298. https://doi.org/10.1016/j.jocn.2012.01.056

    Article  Google Scholar 

  52. Harrop JS, Ganju A, Groff M, Bilsky M (2009) Primary intramedullary tumors of the spinal cord. Spine 34:S69–S77. https://doi.org/10.1097/BRS.0b013e3181b95c6f

    Article  PubMed  Google Scholar 

  53. Samuel N, Tetreault L, Santaguida C et al (2016) Clinical and pathological outcomes after resection of intramedullary spinal cord tumors: a single-institution case series. Neurosurg Focus 41:E8. https://doi.org/10.3171/2016.5.FOCUS16147

    Article  PubMed  Google Scholar 

  54. Brotchi J, Fischer G (1998) Spinal cord ependymomas. Neurosurg Focus 4:e2

    Article  CAS  PubMed  Google Scholar 

  55. Ruda R, Gilbert M, Soffietti R (2008) Ependymomas of the adult: molecular biology and treatment. Curr Opin Neurol 21:754–761. https://doi.org/10.1097/WCO.0b013e328317efe8

    Article  PubMed  Google Scholar 

  56. Oh MC, Ivan ME, Sun MZ et al (2013) Adjuvant radiotherapy delays recurrence following subtotal resection of spinal cord ependymomas. Neuro-Oncology 15:208–215. https://doi.org/10.1093/neuonc/nos286

    Article  CAS  PubMed  Google Scholar 

  57. Abdel-Wahab M, Etuk B, Palermo J et al (2006) Spinal cord gliomas: a multi-institutional retrospective analysis. Int J Radiat Oncol Biol Phys 64:1060–1071. https://doi.org/10.1016/j.ijrobp.2005.09.038

    Article  PubMed  Google Scholar 

  58. Bostrom A, Kanther NC, Grote A, Bostrom J (2014) Management and outcome in adult intramedullary spinal cord tumours: a 20-year single institution experience. BMC Res Notes 7:908. https://doi.org/10.1186/1756-0500-7-908

    Article  PubMed  PubMed Central  Google Scholar 

  59. Garces-Ambrossi GL, McGirt MJ, Mehta VA et al (2009) Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases. J Neurosurg Spine 11:591–599. https://doi.org/10.3171/2009.4.SPINE08159

    Article  PubMed  Google Scholar 

  60. Karikari IO, Nimjee SM, Hodges TR et al (2011) Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients. Neurosurgery 68:188–197; discussion 197. https://doi.org/10.1227/NEU.0b013e3181fe3794

    Article  PubMed  Google Scholar 

  61. Klekamp J (2015) Spinal ependymomas. Part 1: intramedullary ependymomas. Neurosurg Focus 39:E6. https://doi.org/10.3171/2015.5.FOCUS15161

    Article  PubMed  Google Scholar 

  62. Kucia EJ, Bambakidis NC, Chang SW, Spetzler RF (2011) Surgical technique and outcomes in the treatment of spinal cord ependymomas, part 1: intramedullary ependymomas. Neurosurgery 68:57–63; discussion 63. https://doi.org/10.1227/NEU.0b013e318208f181

    Article  PubMed  Google Scholar 

  63. Lee SH, Chung CK, Kim CH et al (2013) Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea Spinal Oncology Research Group. Neuro-Oncology 15:921–929. https://doi.org/10.1093/neuonc/not038

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Yang S, Yang X, Hong G (2009) Surgical treatment of one hundred seventy-four intramedullary spinal cord tumors. Spine 34:2705–2710. https://doi.org/10.1097/BRS.0b013e3181b43484

    Article  PubMed  Google Scholar 

  65. Sgouros S, Malluci CL, Jackowski A (1996) Spinal ependymomas—the value of postoperative radiotherapy for residual disease control. Br J Neurosurg 10:559–566

    Article  CAS  PubMed  Google Scholar 

  66. Tarapore PE, Modera P, Naujokas A et al (2013) Pathology of spinal ependymomas: an institutional experience over 25 years in 134 patients. Neurosurgery 73:247–255; discussion 255. https://doi.org/10.1227/01.neu.0000430764.02973.78

    Article  PubMed  Google Scholar 

  67. Safaee M, Oh MC, Mummaneni PV et al (2014) Surgical outcomes in spinal cord ependymomas and the importance of extent of resection in children and young adults. J Neurosurg Pediatr 13:393–399. https://doi.org/10.3171/2013.12.PEDS13383

    Article  PubMed  Google Scholar 

  68. Li TY, Chu JS, Xu YL et al (2014) Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients: clinical article. J Neurosurg Spine 21:249–259. https://doi.org/10.3171/2014.3.SPINE13481

    Article  PubMed  Google Scholar 

  69. Epstein FJ, Farmer JP, Freed D (1992) Adult intramedullary astrocytomas of the spinal cord. J Neurosurg 77:355–359. https://doi.org/10.3171/jns.1992.77.3.0355

    Article  CAS  PubMed  Google Scholar 

  70. Minehan KJ, Shaw EG, Scheithauer BW, Davis DL, Onofrio BM (1995) Spinal cord astrocytoma: pathological and treatment considerations. J Neurosurg 83:590–595. https://doi.org/10.3171/jns.1995.83.4.0590

    Article  CAS  PubMed  Google Scholar 

  71. Fakhreddine MH, Mahajan A, Penas-Prado M et al (2013) Treatment, prognostic factors, and outcomes in spinal cord astrocytomas. Neuro-Oncology 15:406–412. https://doi.org/10.1093/neuonc/nos309

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Adams H, Avendano J, Raza SM, Gokaslan ZL, Jallo GI, Quinones-Hinojosa A (2012) Prognostic factors and survival in primary malignant astrocytomas of the spinal cord: a population-based analysis from 1973 to 2007. Spine 37:E727–E735. https://doi.org/10.1097/BRS.0b013e31824584c0

    Article  PubMed  Google Scholar 

  73. Beyer S, von Bueren AO, Klautke G et al (2016) A systematic review on the characteristics, treatments and outcomes of the patients with primary spinal glioblastomas or gliosarcomas reported in literature until March 2015. PLoS One 11:e0148312. https://doi.org/10.1371/journal.pone.0148312

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. McGirt MJ, Goldstein IM, Chaichana KL, Tobias ME, Kothbauer KF, Jallo GI (2008) Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients. Neurosurgery 63:55–60; discussion 60-51. https://doi.org/10.1227/01.NEU.0000335070.37943.09

    Article  PubMed  Google Scholar 

  75. Tovar Martin MI, Lopez Ramirez E, Saura Rojas E, Arregui Castillo G, Zurita Herrera M (2011) Spinal cord astrocytoma: multidisciplinary experience. Clin Transl Oncol 13:185–188

    Article  PubMed  Google Scholar 

  76. Babu R, Karikari IO, Owens TR, Bagley CA (2014) Spinal cord astrocytomas: a modern 20-year experience at a single institution. Spine 39:533–540. https://doi.org/10.1097/BRS.0000000000000190

    Article  PubMed  Google Scholar 

  77. Cooper PR (1989) Outcome after operative treatment of intramedullary spinal cord tumors in adults: intermediate and long-term results in 51 patients. Neurosurgery 25:855–859

    Article  CAS  PubMed  Google Scholar 

  78. Cristante L, Herrmann HD (1994) Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery 35:69–74 discussion 74-66

    Article  CAS  PubMed  Google Scholar 

  79. Ardeshiri A, Chen B, Hutter BO et al (2013) Intramedullary spinal cord astrocytomas: the influence of localization and tumor extension on resectability and functional outcome. Acta Neurochir 155:1203–1207. https://doi.org/10.1007/s00701-013-1762-5

    Article  PubMed  Google Scholar 

  80. Sandalcioglu IE, Gasser T, Wiedemayer H, Horsch S, Stolke D (2002) Favourable outcome after biopsy and decompression of a holocord intramedullary spinal cord astrocytoma in a newborn. Eur J Paediatr Neurol : EJPN : Off J Eur Paediatr Neurol Soc 6:179–182

    Article  Google Scholar 

  81. Chacko AG, Chandy MJ (2000) Favorable outcome after radical excision of a ‘Holocord’ astrocytoma. Clin Neurol Neurosurg 102:240–242

    Article  CAS  PubMed  Google Scholar 

  82. Elsberg CA, Beer, E. (1911) The operability of intramedullary tumors of the spinal cord. A report of two operations, with remarks upon the extrusion of intraspinal tumors. Am J Med Sci: 636–647

  83. Tobias ME, McGirt MJ, Chaichana KL et al (2008) Surgical management of long intramedullary spinal cord tumors. Child's Nervous system : ChNS : Off J Int Soc Pediatric Neurosurg 24:219–223. https://doi.org/10.1007/s00381-007-0405-7

    Article  Google Scholar 

  84. Ebner FH, Schittenhelm J, Roser F, Scheel-Walter H, Tatagiba M, Schuhmann MU (2012) Management of holocord pilocytic astrocytomas in children and adolescents: an update. Pediatr Neurosurg 48:133–140. https://doi.org/10.1159/000345593

    Article  PubMed  Google Scholar 

  85. Kim TY, Yoon DH, Shin HC et al (2012) Spinal cord hemangioblastomas in von Hippel-Lindau disease: management of asymptomatic and symptomatic tumors. Yonsei Med J 53:1073–1080. https://doi.org/10.3349/ymj.2012.53.6.1073

    Article  PubMed  PubMed Central  Google Scholar 

  86. Yang C, Li G, Fang J et al (2014) Intramedullary gangliogliomas: clinical features, surgical outcomes, and neuropathic scoliosis. J Neuro-Oncol 116:135–143. https://doi.org/10.1007/s11060-013-1267-3

    Article  Google Scholar 

  87. Elavarasi A, Dash D, Warrier AR et al (2018) Spinal cord involvement in primary CNS lymphoma. J Clin Neurosc : Off J Neurosurg Soc Australas 47:145–148. https://doi.org/10.1016/j.jocn.2017.10.027

    Article  Google Scholar 

  88. Tan LA, Kasliwal MK, Mhanna N, Fontes RB, Traynelis VC (2014) Surgical resection of subependymoma of the cervical spinal cord. Neurosurgical Focus 37(Suppl 2):Video 3. https://doi.org/10.3171/2014.V3.FOCUS14258

    Article  PubMed  Google Scholar 

  89. Sharma S, Sarkar C, Gaikwad S, Suri A, Sharma MC (2005) Primary neurocytoma of the spinal cord: a case report and review of literature. J Neuro-Oncol 74:47–52. https://doi.org/10.1007/s11060-004-3348-9

    Article  Google Scholar 

  90. Kim JE, Lim M (2015) Neurocytoma of the spinal cord. Neurosurg Clin N Am 26:109–115. https://doi.org/10.1016/j.nec.2014.09.005

    Article  PubMed  Google Scholar 

  91. Strickland BA, McCutcheon IE, Chakrabarti I, Rhines LD, Weinberg JS (2018) The surgical treatment of metastatic spine tumors within the intramedullary compartment. J Neurosurg Spine 28:79–87. https://doi.org/10.3171/2017.5.SPINE161161

    Article  PubMed  Google Scholar 

  92. Costa P, Peretta P, Faccani G (2013) Relevance of intraoperative D wave in spine and spinal cord surgeries. Eur Spine J : Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Section Cervical Spine Res Soc 22:840–848. https://doi.org/10.1007/s00586-012-2576-5

    Article  Google Scholar 

  93. Angevine PD, Kellner C, Haque RM, McCormick PC (2011) Surgical management of ventral intradural spinal lesions. J Neurosurg Spine 15:28–37. https://doi.org/10.3171/2011.3.SPINE1095

    Article  PubMed  Google Scholar 

  94. Ottenhausen M, Krieg SM, Meyer B, Ringel F (2015) Functional preoperative and intraoperative mapping and monitoring: increasing safety and efficacy in glioma surgery. Neurosurg Focus 38:E3. https://doi.org/10.3171/2014.10.FOCUS14611

    Article  PubMed  Google Scholar 

  95. Morota N, Deletis V, Constantini S, Kofler M, Cohen H, Epstein FJ (1997) The role of motor evoked potentials during surgery for intramedullary spinal cord tumors. Neurosurgery 41:1327–1336

    Article  CAS  PubMed  Google Scholar 

  96. Yamamoto T, Katayama Y, Nagaoka T, Kobayashi K, Fukaya C (2004) Intraoperative monitoring of the corticospinal motor evoked potential (D-wave): clinical index for postoperative motor function and functional recovery. Neurol Med Chir 44:170–180 discussion 181-172

    Article  Google Scholar 

  97. Deletis V, Sala F (2008) Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: a review focus on the corticospinal tracts. Clin Neurophysiol 119:248–264. https://doi.org/10.1016/j.clinph.2007.09.135

    Article  PubMed  Google Scholar 

  98. Kothbauer KF, Deletis V, Epstein FJ (1998) Motor-evoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in a series of 100 consecutive procedures. Neurosurg Focus 4:e1

    Article  CAS  PubMed  Google Scholar 

  99. Cheng JS, Ivan ME, Stapleton CJ, Quinones-Hinojosa A, Gupta N, Auguste KI (2014) Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors. J Neurosurg Pediatr 13:591–599. https://doi.org/10.3171/2014.2.PEDS1392

    Article  PubMed  PubMed Central  Google Scholar 

  100. Kelleher MO, Tan G, Sarjeant R, Fehlings MG (2008) Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. J Neurosurg Spine 8:215–221. https://doi.org/10.3171/SPI/2008/8/3/215

    Article  PubMed  Google Scholar 

  101. Forster MT, Marquardt G, Seifert V, Szelenyi A (2012) Spinal cord tumor surgery—importance of continuous intraoperative neurophysiological monitoring after tumor resection. Spine 37:E1001–E1008. https://doi.org/10.1097/BRS.0b013e31824c76a8

    Article  PubMed  Google Scholar 

  102. Tsuda K, Akutsu H, Yamamoto T, Nakai K, Ishikawa E, Matsumura A (2014) Is Simpson grade I removal necessary in all cases of spinal meningioma? Assessment of postoperative recurrence during long-term follow-up. Neurol Med Chir 54:907–913

    Article  Google Scholar 

  103. Kim CH, Chung CK, Lee SH et al (2016) Long-term recurrence rates after the removal of spinal meningiomas in relation to Simpson grades. Euro Spine J : Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Section of the Cervical Spine Res Soc 25:4025–4032. https://doi.org/10.1007/s00586-015-4306-2

    Article  Google Scholar 

  104. Castillo M, Quencer RM, Green BA, Montalvo BM (1988) Syringomyelia as a consequence of compressive extramedullary lesions: postoperative clinical and radiological manifestations. AJR Am J Roentgenol 150:391–396. https://doi.org/10.2214/ajr.150.2.391

    Article  CAS  PubMed  Google Scholar 

  105. Nuwer MR, Emerson RG, Galloway G et al (2012) Evidence-based guideline update: intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials*. J Clin Neurophysiol : Off Publ Am Electroencephalogr Soc 29:101–108. https://doi.org/10.1097/WNP.0b013e31824a397e

    Article  Google Scholar 

  106. Sala F, Palandri G, Basso E et al (2006) Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery 58:1129–1143; discussion 1129-1143. https://doi.org/10.1227/01.NEU.0000215948.97195.58

    Article  PubMed  Google Scholar 

  107. Sweeney KJRM, Farell M, Bolger C (2017) Gross total resection rates of grade II/III intramedullary ependymomas using the surgical strategy of en-bloc resection without intra-operative neurophysiological monitoring. Br J Neurosurg 31:363–368

    Article  Google Scholar 

  108. Krzan MDV, Isgum V (1997) Intraoperative neurophysiological mapping of dorsal columns. A new tool in the prevention of surgically induced sensory deficit? Electroendephalogr Clin Neurophysiol 102:37

    Article  Google Scholar 

  109. Nuwer MR, Dawson EG, Carlson LG, Kanim LE, Sherman JE (1995) Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol 96:6–11

    Article  CAS  PubMed  Google Scholar 

  110. Kothbauer KF (2007) Intraoperative neurophysiologic monitoring for intramedullary spinal-cord tumor surgery. Neurophysiologie clinique = Clin Neurophysiol 37:407–414. https://doi.org/10.1016/j.neucli.2007.10.003

    Article  CAS  Google Scholar 

  111. Takami T, Yamagata T, Ohata K (2013) Posterolateral sulcus approach for spinal intramedullary tumor of lateral location: technical note. Neurol Med Chir 53:920–927

    Article  Google Scholar 

  112. Kumar A, Deopujari CE, Karmarkar VS (2012) Dorsal root entry zone approach in ventral and eccentric intramedullary tumors: a report of 2 cases. Asian J Neurosurg 7:32–35. https://doi.org/10.4103/1793-5482.95695

    Article  PubMed  PubMed Central  Google Scholar 

  113. Ogden AT, Feldstein NA, McCormick PC (2008) Anterior approach to cervical intramedullary pilocytic astrocytoma. Case report. J Neurosurg Spine 9:253–257. https://doi.org/10.3171/SPI/2008/9/9/253

    Article  PubMed  Google Scholar 

  114. Isaacson SR (2000) Radiation therapy and the management of intramedullary spinal cord tumors. J Neuro-Oncol 47:231–238

    Article  CAS  Google Scholar 

  115. Hamilton AJ, Lulu BA, Fosmire H, Stea B, Cassady JR (1995) Preliminary clinical experience with linear accelerator-based spinal stereotactic radiosurgery. Neurosurgery 36:311-319

    Article  Google Scholar 

  116. Dodd RL, Ryu MR, Kamnerdsupaphon P, Gibbs IC, Chang SD Jr, Adler JR Jr (2006) CyberKnife radiosurgery for benign intradural extramedullary spinal tumors. Neurosurgery 58:674–685; discussion 674-685. https://doi.org/10.1227/01.NEU.0000204128.84742.8F

    Article  PubMed  Google Scholar 

  117. Marchetti M, De Martin E, Milanesi I, Fariselli L (2013) Intradural extramedullary benign spinal lesions radiosurgery. Medium- to long-term results from a single institution experience. Acta Neurochir 155:1215–1222. https://doi.org/10.1007/s00701-013-1756-3

    Article  PubMed  Google Scholar 

  118. Bennett EE, Berriochoa C, Habboub G, Brigeman S, Chao ST, Angelov L (2017) Rapid and complete radiological resolution of an intradural cervical cord lung cancer metastasis treated with spinal stereotactic radiosurgery: case report. Neurosurg Focus 42:E10. https://doi.org/10.3171/2016.9.FOCUS16254

    Article  PubMed  Google Scholar 

  119. Gerszten PC, Burton SA, Ozhasoglu C, McCue KJ, Quinn AE (2008) Radiosurgery for benign intradural spinal tumors. Neurosurgery 62:887–895; discussion 895-886. https://doi.org/10.1227/01.neu.0000318174.28461.fc

    Article  PubMed  Google Scholar 

  120. Shin DA, Huh R, Chung SS, Rock J, Ryu S (2009) Stereotactic spine radiosurgery for intradural and intramedullary metastasis. Neurosurg Focus 27:E10. https://doi.org/10.3171/2009.9.FOCUS09194

    Article  PubMed  Google Scholar 

  121. Hernandez-Duran S, Hanft S, Komotar RJ, Manzano GR (2016) The role of stereotactic radiosurgery in the treatment of intramedullary spinal cord neoplasms: a systematic literature review. Neurosurg Rev 39:175–183; discussion 183. https://doi.org/10.1007/s10143-015-0654-y

    Article  PubMed  Google Scholar 

  122. Monserrate A, Zussman B, Ozpinar A, Niranjan A, Flickinger JC, Gerszten PC (2017) Stereotactic radiosurgery for intradural spine tumors using cone-beam CT image guidance. Neurosurg Focus 42:E11. https://doi.org/10.3171/2016.9.FOCUS16356

    Article  PubMed  Google Scholar 

  123. Saraceni C, Ashman JB, Harrop JS (2009) Extracranial radiosurgery—applications in the management of benign intradural spinal neoplasms. Neurosurg Rev 32:133–140; discussion 140-131. https://doi.org/10.1007/s10143-008-0183-z

    Article  PubMed  Google Scholar 

  124. Harel R, Pfeffer R, Levin D et al (2017) Spine radiosurgery: lessons learned from the first 100 treatment sessions. Neurosurg Focus 42:E3. https://doi.org/10.3171/2016.9.FOCUS16332

    Article  PubMed  Google Scholar 

  125. Yamada Y, Katsoulakis E, Laufer I et al (2017) The impact of histology and delivered dose on local control of spinal metastases treated with stereotactic radiosurgery. Neurosurg Focus 42:E6. https://doi.org/10.3171/2016.9.FOCUS16369

    Article  PubMed  PubMed Central  Google Scholar 

  126. Sharma M, Bennett EE, Rahmathulla G et al (2017) Impact of cervicothoracic region stereotactic spine radiosurgery on adjacent organs at risk. Neurosurg Focus 42:E14. https://doi.org/10.3171/2016.10.FOCUS16364

    Article  PubMed  Google Scholar 

  127. Goyal S, Puri T, Julka PK (2015) Holocord low grade astrocytoma—role of radical irradiation and chemotherapy. J Egyp Nat Cancer Instit 27:105–108. https://doi.org/10.1016/j.jnci.2015.01.001

    Article  Google Scholar 

  128. Mehta AI, Adogwa O, Karikari IO et al (2013) Anatomical location dictating major surgical complications for intradural extramedullary spinal tumors: a 10-year single-institutional experience. J Neurosurg Spine 19:701–707. https://doi.org/10.3171/2013.9.SPINE12913

    Article  PubMed  Google Scholar 

  129. Slin'ko EI, Al Q II (2004) Intradural ventral and ventrolateral tumors of the spinal cord: surgical treatment and results. Neurosurg Focus 17:ECP2

    Article  PubMed  Google Scholar 

  130. Ahn DK, Park HS, Choi DJ, Kim KS, Kim TW, Park SY (2009) The surgical treatment for spinal intradural extramedullary tumors. Clin Orthop Surg 1:165–172. https://doi.org/10.4055/cios.2009.1.3.165

    Article  PubMed  PubMed Central  Google Scholar 

  131. Ebner FH, Roser F, Falk M, Hermann S, Honegger J, Tatagiba M (2010) Management of intramedullary spinal cord lesions: interdependence of the longitudinal extension of the lesion and the functional outcome. Eur Spine J : Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Section of the Cervical Spine Res Soc 19:665–669. https://doi.org/10.1007/s00586-009-1232-1

    Article  Google Scholar 

  132. Xiao R, Miller JA, Abdullah KG, Lubelski D, Mroz TE, Benzel EC (2016) Quality of life outcomes following resection of adult intramedullary spinal cord tumors. Neurosurgery 78:821–828. https://doi.org/10.1227/NEU.0000000000001147

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Alexander Bock, MD, Head of Department of Neuroradiology, Vivantes Klinikum Neukölln, Berlin, Germany, for close clinical cooperation and for providing MR images. We also thank Matthew Holt, Medical Illustrator, for the outstanding medical illustrations.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Vivantes Klinikum Neukölln, Berlin, Germany

    Malte Ottenhausen, Georgios Ntoulias, Finn-Hannes Ruppert, Stefan Schreiber & Andreas Jödicke

  2. The Feinstein Institute for Medical Research, Manhasset, USA

    Imithri Bodhinayake

  3. Department of Radiology and Neuroradiology, Schlossparkklinik, Berlin, Germany

    Annette Förschler

  4. Department of Neurosurgery, Lenox Hill Hospital, New York, USA

    John A. Boockvar

Authors
  1. Malte Ottenhausen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georgios Ntoulias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Imithri Bodhinayake
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Finn-Hannes Ruppert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefan Schreiber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Annette Förschler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John A. Boockvar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andreas Jödicke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Jödicke.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants for whom identifying information is included in this article.

Electronic supplementary material

Video 1

Removal of a dumbbell-shaped cervical spinal schwannoma (C2/3) using a right-sided anterolateral approach (FLV 6770 kb)

Video 2

En bloc removal of an intramedullary cervical ependymoma via a multi-level laminotomy by microsurgical dissection (FLV 26544 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ottenhausen, M., Ntoulias, G., Bodhinayake, I. et al. Intradural spinal tumors in adults—update on management and outcome. Neurosurg Rev 42, 371–388 (2019). https://doi.org/10.1007/s10143-018-0957-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-018-0957-x

Keywords

Search

Navigation