Spinal tumors constitute approximately 20% of CNS tumors. They are classified as intradural or extradural. Of the intradural ones, 84% are outside the spinal cord (extramedullary) and 16% are inside (intramedullary). Intradural tumors are almost always primary CNS tumors. In contrast, the majority of extradural tumors are either metastatic or primary bone tumors. Most intradural spine neoplasms are benign/non-malignant and can usually be surgically removed. Tumors in the spinal cord (intradural, intramedullary) tend to cause weakness, spasticity and loss of sensation. Extramedullary lesions present with cord compression and long tract (upper motor neuron) symptoms as well as radicular pain caused by nerve root (lower motor neuron) compression. In patients with lesions involving the conus medullaris region, loss of bladder and large intestine functions is observed in the early period, in patients with lesions in the cauda equina, leg pain first and then sphincter disorders occur in the late period.
MRI is the determinant for the definitive diagnosis of spinal tumors.
Neurilemoma and Neurofibroma
They are typically benign. These are the most common spinal cord tumors and account for approximately 30% of all. They usually show intradural, extramedullary localization. 13% of these extend extradurally from the adjacent neural foramen; they take the form of classical “dumbell” tumors. 14% are completely extradural. Its extradural components tend to enlarge the relevant foramen. Treatment is surgical removal of the tumor. Multiple neurofibromas are seen with von Recklinghausen neurofibromatosis. In such cases, only symptomatic tumors should be removed.
Meningioma
Meningiomas constitute 26% of spinal cord tumors, they are benign and usually intradural, extramedullary. 15% are seen extradurally. 2/3 of them occur in the thoracic region and 80% of cases affect women in the 40-60 age group. Surgical removal is the preferred treatment.
Ependymoma
They arise from ependymal cells of the central canal of the spinal cord and these intramedullary tumors constitute 13% of all spinal cord tumors. It is more common in men. About 60% is located in the conus medullaris region. Ependymomas must be surgically removed. Being well circumscribed usually allows their total removal. Radiation therapy is usually used when it is not possible to remove it completely.
Astrocytoma
These glial tumors arise from astrocytes and are often intramedullary. Their incidence is almost the same as that of spinal ependymomas. Complete removal is rarely possible due to their infiltrative nature. Low-grade astrocytomas are usually re-operated if they recur. Radiation therapy is applied for malignant astrocytomas but is usually only for palliative purposes. Although spinal cord astrocytomas grow slowly, their prognosis is generally poor.
Lipoma
Lipomas constitute 10% of spinal tumors and are usually seen together with spina bifida and a subcutaneous lipoma. Although they are benign, they are usually partially removed because they tend to stick to the spinal cord. These do not require radiotherapy and have a low mortality rate.
Dermoid
Dermoids are congenital lesions and are usually found in the lumbosacral region. They are usually seen with a sinus tract extending to the skin surface and may present with infection. Their treatment is surgical removal along with the sinus tract. The parts extending to the spinal cord are usually not removable. Long-term prognosis is good.
Metastatic Tumor
Up to 25% of spinal neoplasms are of metastatic origin and the majority of them are located extradurally. Often the primers; breast, lung, prostate and kidney. If the primary focus is unknown or neurologic deterioration is rapid, treatment is surgery combined with biopsy. Otherwise, local radiotherapy should be preferred. Other extradural malignant tumors include lymphoma, myeloma, plasmacytoma, chordoma, and osteogenic sarcoma. Spinal stabilization may be impaired as a result of significant bone destruction or surgical decompression, in such cases surgical stabilization via the anterior or posterior route is often required.
Peripheral Nerve Tumors
Peripheral nervous system; It consists of peripheral and cranial nerves, spinal roots, and the autonomic nervous system. Tumors can develop from any of these. The most common tumors are discussed below. Less common tumors are gangliogliomas, neuroblastomas, pargangliomas, chemodectomas, and pheochromocytomas.
Schwannoma
This tumor consists of Schwann cells of peripheral nerves, which make the myelin sheath of axons. Schwannomas tend to push the nerve they originate from, and therefore they usually appear as painless masses. If the enlargement continues, they can cause pain in areas that match the distribution of the nerve. As they grow, they impair nerve functions. They usually occur in sensory nerves but can also be found in motor nerves. Its treatment is surgery. The nerve from which they originate is usually spared. In some cases, however, complete removal of the tumor may require substantial severing of the main nerve. If the nerve has a very important function, it is preferable to leave a part of the tumor to protect the nerve. This is an acceptable method because malignant transformation is rare in these tumors.
Neurofibroma
Unlike schwannomas, neurofibromas envelop and compress the nerve they originate from because they develop from the nerve itself. Since they are usually seen on the skin, they make it difficult to detect the nerve from which they originate. When co-occurring with von Rechinghausen neurofibromtosis, they are usually found more than once. If a single lesion is present, its treatment is surgical removal. If more than one tumor is present, only symptomatic ones should be removed. If the function of the nerve is critical, a portion of the tumor attached to the nerve should be left. Unlike cases of schwannoma, patients with neurofibroma should be followed closely because of the high rate of malignant transformation of these tumors.
Malignant Nerve Sheath Tumor
These tumors typically occur over 30 years of age. The treatment of choice is a radical and wide surgical excision. If there is evidence of muscle or soft tissue invasion, amputation of the involved extremity is recommended. These tumors are usually resistant to radiation therapy.
