1. Khaled M F SAOUD Professor of neurosurgery, Ain shams university
Spinal Tumors
Khaled M F SAOUD
Professor of neurosurgery, Ain shams university

2. Collaboration

3. Diagnosis and Management

6. Epidemiology 15% of primary CNS tumors are intraspinal
Intracranial: intraspinal ratio of astrocytoma is 10 :1, and for ependymomas 3-20 :1.
Most of primary CNS Spinal tumors are benign!!.

7. Anatomical Classification of Spinal Cord Tumors
Extradural : Benign and malignant verteberal tumors, tumors near the spinal cord.
Intradural tumors
Extramedullary: nerve sheath and menengial
Intramedullary: glial and other

8. Intra-dural Lesions

9. Meningioma Slow growing benign masses
~15% of all meningiomas are spinal
5:1 female to male ratio
Typically intradural extramedullary but can be extadural
Most commonly thoracic in location, Cervical second most common

10. Schwannomas

11. Neurofibromas and Neurofibromatosis
Commonly seen in NF-1
Occur more frequently in the cervical spine in NF-1
May be intradural, extradural or dumbell
Often multiple
Sometimes plexiform
Benign
Fusiform expansion of the nerve (Schwann, perineural and neural cells)
Difficult to get complete resection because of the extra-foramenal extension and risk of functional loss

13. Ependymomas Seen in adults, 15 to 40 Male = Female
Presenting signs depend on location
Longer duration, more severe symptoms = less favorable functional outcome with surgery
Arise from ependymal lining of the central canal & from filum terminale
Sometimes associated with a syrinx
Filum origin usually myxopapillary type
Very rarely malignant
Total resection is possible in the majority of tumors
The goal of surgery is complete resection with good functional outcome
Functional improvement common after resection
Progression free survival similar for total resection vs partial resection + RT

14. Conus and filum terminale

16. Astrocytoma Occur at any age, average age of dx is 35 to 40
Accompanying syrinx in 40%
Occurs equally throughout cord
Presenting sign depend upon location
Most are grade I or II
Complete surgical resection is impossible
RT recommended after dx
Outcomes similar for biopsy + RT and resection + RT
Low grade recurrent tumor can be treated with reresection

17. Spinal radiosurgery?

18. Hemangioblastoma
Highly vascular tumors comprising 2% of spinal cord tumors
¼ associated with von Hippel-Lindau, ¾ sporadic
10 times less common than intracranial
Male predominance
Presents mid life
Spinal Angiography?

19. Cavernous Angioma Often dorsally located and comes to surface
Hemosiderin stained
Resection with second hemorrhage or progressive deficit
Thin walled abnormal vascular channels
Spinal radiosurgery??

20. Lipoma Typically associated with spinal dysrahpism
Presents like any space occupying lesion with progressive myelopathy
Onset of symptoms often associated with weight gain
Treatment is surgical with debulking of the tumor and duraplasty
Must take care not to injure normal spinal cord.

21. Spinal metastasis
Theatrically can happen anywhere in the spine, ED,ID EM
Treatment depends on the symptoms.

22. Primary Skeletal Neoplasms
Cell of origin
Osseous
Cartilagenous
Fibrous
Benign Malignant
Neoplasms Neoplasms
Osteoid osteoma Osteosarcoma
Osteoblastoma ( and variants
Osteochondroma
Enchondroma
Chondroblastoma
Chondromyxoid-
fibroma
Chondrosarcoma
Primary, secondary
Fibrosarcoma
Malignant fibrous
Histiocytoma
Fibroma

23. Vertebral hemangioma Most common benign spinal neoplasm.
More in the thoracic and lumber spine.
Mostly asymptomatic.
May present with pain or rarely neurological deficit.

24. Vertebral hemangiomas

25. Spinal radiosurgery Why? Indications Post resection local irradiation
Disease progression despite previous surgery and/or irradiation
Patients with severe medical comorbidities that preclude surgery
Inoperable lesions

26. Components Immobilization device Radiation unit Beam shaping unit
Respiratory tracking unit

28. Respiratory tracking

30. Cyber Knife (Frameless SRS):
Real-time X-ray imaging to establish the position of the lesion during treatment
The patient wears a vest that contains LED external Fiducials.

31. Objectives of spinal RS in spinal mets:
Pain relief (up to 90%)
Control of progression (80-90%) –lung and breast best prognosis

32. Combined kyphoplasty and spinal radiosurgery for spinal mets COMPRESSION FRACTURES

33. Spinal arteriovenous malformations

34. Indications
Comorbidities
Residual/recurrent tumors

35. Teamwork Clinical Oncology Neurology Professor Dr Khaled Abdelkarim
Professor Dr Mohamed Sabry AlKady
Professor Dr Mohamed Yassin Mostafa
Neurology
Professor Dr Ahmed AbdelMenem Gaber