1. Intramedullary spinal cord tumors
Rekha Meesa, MD MS
Summit/Synergy Radiology
edited by Akash Meesa

2. Introduction
Spinal cord tumors account for 2-5% of central nervous neoplasms in adults
Intramedullary tumors
- 20% of intraspinal tumors in adults
- 35% of intraspinal tumors in children
Often a history of long duration of symptoms prior to diagnosis

3. Classification Various types of classifications
Intramedullary neoplastic lesions
a. Glial neoplasms
1. Spinal ependymoma
2. Spinal astrocytoma
3. Spinal ganglioma
b. Non-glial neoplasms
1. Highly vascular lesions
- spinal hemangioblastoma
2. Other rare lesions
- intramedullary metastasis
Intramedullary benign masses
a. Spinal canal lipoma

4. Spinal Astrocytoma
Intramedullary astrocytomas represent only 6-8% of spinal cord tumors
Cord expansion often <5 segments
Most common intramedullary tumor in young children
Imaging: Intramedullary enhancing mass
Often slow-growing
Treatment: Microsurgical resection

5. Aggressive Anaplastic Astrocytoma with intracranial metastasis
Intracranial dissemination of spinal cord gliomas is rare
Metastasize to the brain by direct leptomeningeal, cerebrospinal fluid (CSF) pathways and rarely by bloodstream
- Tumor cells can disseminate to the basal
cisterns, cistern magna causing
communicating hydrocephalus

6. Sagittal T1 weighted image of the cervical and upper thoracic spine demonstrate heterogeneous expansile masses in the thoracic cord and some lesions in the cervical cord.

7. Sagittal T2 weighted image of the spine demonstrates multiple T2 bright expansile lesions in the cord.

8. Sagittal post contrast T1 weighted image of the spine demonstrates a large enhancing intramedullary mass and other small enhancing lesions. Note is also made of abnormal leptomeningeal enhancement along the surface of the cord.

9. Axial post contrast image of the brain demonstrates abnormal enhancement of the basilar cisterns consistent with leptomeningeal spead of disease.

10. Spinal Ependymoma Neoplasm of ependyma lining of spinal cord canal
Circumscribed, enhancing cord mass with hemorrhage

11. Age: 35 – 45 yo
WHO grade II or grade III
Associated with: subarachnoid hemorrhage, superficial siderosis, NF2
Treatment: surgical resection

12. Sagittal T1 MR image of the cervical spine demonstrates a large expansile mass in the upper cervical cord.

13. Sagittal T2 weighted MR image of the cervical spine demonstrates a T2 bright expansile mass in the upper cervical spine.

14. Sagittal post contrast T1 weighted MR image of the cervical spine demonstrates a mildly enhancing mass in the upper cervical cord.

15. Spinal Hemangioblastoma
Low grade, capillary rich neoplasms of cerebellum and spinal cord
a. Occur sporadically(75% or in setting of
von Hippel-Lindau (VHL syndrome)
b. Intramedullary mass with “flow voids”
c. Extramedullary spinal HBs occur, but rare

16. Sagittal T2 weighted MR image of the cervical spine demonstrates a cystic mass with a mural nodule in the cervical cord.

17. Sagittal post contrast T1 weighted MR image of the cervical spine demonstrates a cystic mass with an enhancing mural nodule in the cervical cord.

18. von Hippel-Lindau syndrome
Cerebellar HBs, retinal angiomas, pheochromocytoma, renal cell carcinoma, angiomatous or cystic lesions of kidneys, pancreas, and epididymis

19. Differential Diagnosis
a. Arteriovenous malformation
b. Cavernous malformation
c. Hypervascular cord neoplasms
d. Intradural/extramedullary tumors

20. Symptoms
- Nonspecific
- Sensory/motor > pain
95% symptoms-producing associated with syringomyelia
Treatment
- Microsurgical resection

21. References
Kataria R, Bhasme V, Chopra S, Sinha VD, Singhvi S. Intracranial metastasis of spinal intramedullary anaplastic astrocytoma. Asian J Neurosurg Jul-Dec; 6(2):
Statdx