Spinal Cord Tumors

Spinal cord tumors are divided into two groups as tumors that develop from the spinal cord itself and develop from the spinal cord membrane and nerves. They can cause different types of paralysis, loss of sense, urinary, and fecal problems, both by making pressure on the spinal cord and by destroying the spinal cord. It is less common in both adults and children compared to brain tumors. The most common tumors of the spinal cord are astrocytoma and ependymoma, while meningioma is the most common tumor in the spinal cord membrane, and schwannoma is the most common tumor in the spinal cord which originates from the nerves in the spinal cord. Spinal cord tumors may cause cyst formation in the spinal cord above and/or below the site of the tumor.

Symptoms

Spinal cord tumors show signs according to location and spinal cord compression. There may be the neck, back, and low back pain. There may be a loss of strength and/or sensory loss in the arms and legs due to spinal cord compression. Urinary and fecal incontinence and balance disorder can be seen. The patient’s complaints, history of the disease and examination is very important in terms of diagnosis.

Diagnosis

Magnetic resonance imaging (MRI) shows the spinal cord and spinal canal in full detail. If present in the spinal cord, they may indicate tumoral formations, and whether they retain contrast material. MR spectroscopy can be used to determine whether the tumor is malignant or benign in tumors that are big enough. In MR tractography, the course of the descending and ascending pathways/fibers in the spinal cord and its relationship with the tumor can be examined.

Sometimes vascular diseases of the spinal cord and glomeruli that cause tumors can be evaluated with angiography.

Electrophysiological tests can be used to evaluate the transmission with the nerves. Nerve roots from the spinal cord are evaluated with EMG (Electromyography). MEP (Motor Evoked Potentials) evaluates the motor-motion function of the spinal cord, and SEP (Sensory Evoked Potentials) evaluates the degree of influence of the spinal cord’s sensory function.

Treatment

Surgery is the first choice in the treatment of tumors that develop both from the spinal cord itself and from the spinal cord membrane and nerves. Surgery is the first choice in the treatment of benign tumors. Curing is usually achieved by removal of the tumor. In malignant tumors, the tumor is also removed first. Radiotherapy and stereotactic radiosurgery are often used in cases where all tumors cannot be removed, recurrence cases or tumors with malignant characters. Chemotherapy can be used as an adjunct to radiotherapy. The main goal here is to remove the tumor without allowing it to grow very seriously and make serious neurological deficits. In order to protect the spinal cord during surgery and to prevent paralysis of the patient, advanced surgical microscopes and intraoperative neuromonitoring are used almost always.

For neuromonitoring, the patient is anesthetized with special anesthesia techniques. Electrodes are attached to the head and extremities (arms and legs). EMG, MEP, SEP monitoring is performed continuously and in real time throughout the operation. It alerts the surgeon in case of any danger. Although it does not always give 100% correct results, it may help surgery even if there is sometimes a margin of error.

Follow-up

MRI is performed at 3rd, 6th and 12th months after surgery. Close follow-up is necessary for malignant tumors as there is a risk of recurrence.

Astrocytoma

They are usually benign tumors. Rarely they can be malignant. They can cause different types of paralysis by compressing the spinal cord and destroying the spinal cord tissue. Complete recovery is expected when all are removed by surgery.

Ependymoma

These tumors can be both benign and malignant. These tumors, like astrocytomas, can cause different types of paralysis by compressing and destroying the spinal cord tissue. Benign ones can be cured when totally removed. In malignant ones, additional treatments such as radiotherapy may be required. Those who are located at the bottom of the spinal cord are often benign (filum terminale ependymomas). These tumors can develop after the spread of the same type of tumor settled in the brain with cerebrospinal fluid.

Meningioma

These tumors are tumors that develop from the cerebrospinal membranes. Very often they are benign, rarely malignant. In some cases, they are calcified and can be very hard. These tumors usually show signs after compressing the spinal cord resulting in paralysis. Complete recovery is expected when fully removed.

Schwannoma

These tumors develop from the sheath of the nerves coming out of the spinal cord and may extend along the course of the nerve. It may be between the dura membrane and the spinal cord and/or outside the dura, as well as forms that involve both areas and also holding spine bones. They are usually benign, but sometimes they can be malignant. While the benign ones are expected to fully recover when they are completely removed, they may not always be completely removed. Sometimes they can reach very large sizes because of late symptoms. Since these tumors are adjacent to the nerves, it may be necessary to cut the nerves during surgery, which may lead to paralyses such as loss of sense and strength. Malignant ones may require additional treatments such as radiotherapy and chemotherapy in addition to surgery.