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Intramedullary Spinal Cord Tumors Leslie Hutchins, MD Shore Memorial Cancer Conference September 18, 2008
Spinal Cord Anatomy- Meninges ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spinal Cord Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spinal Cord Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],D.E. Haines, Neuroanatomy: An Atlas of Structures, Sections, and Systems, 3rd ed. (1991), Urban & Schwarzenberg Encyclopedia Britannica, Inc.
Spinal Cord Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Motor impairment related to Spinal Cord Injury
Dermatomes
Spinal Cord Cross Section: Fiber Tracts
Spinal Cord Anatomy: Vasculature  ,[object Object],[object Object],[object Object],[object Object]
Spinal Cord Anatomy: Vasculature  ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Spinal Cord Anatomy: Vasculature
Spinal Cord Anatomy: Vasculature ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spinal Cord Anatomy: Vasculature  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spinal Cord Anatomy: Vasculature ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification of Spinal Cord Lesions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification of Spinal Cord Lesions
Pediatric Intramedullary  Spinal Cord Tumors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Clinical Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Kyphoscoliosis
Torticollis
Hydrocephalus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Work-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ependymomas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ependymomas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Myxopapillary Ependymomas ,[object Object],[object Object]
Ependymomas ,[object Object],[object Object]
Anaplastic Ependymomas ,[object Object]
Ependymoma  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Nineteen year-old who presented with finger numbness & “clumsiness”
Ependymoma Kothbauer KF. Neurosurgical Management of Intramedullary Spinal Cord Tumors in Children.  Pediatric Neurosurgery.  2007; 43:222-235.
www.stevenscordfoundation.com
Astrocytoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Astrocytoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pilocytic Astrocytoma ,[object Object],[object Object]
Fibrillary Astrocytomas ,[object Object]
Astrocytomas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thoracic Intramedullary  Pilocytic Astrocytoma Eleven year-old girl presented with 3 month history of low back pain Binning, M. Spinal Tumors in Children.  Neurosurg Clin N Am. 2007; 18: 631-658
Pilocytic Astrocytoma Kothbauer KF. Neurosurgical Management of Intramedullary Spinal Cord Tumors in Children.  Pediatric Neurosurgery.  2007; 43:222-235.
Fibrillary Astrocytoma Kothbauer KF. Neurosurgical Management of Intramedullary Spinal Cord Tumors in Children.  Pediatric Neurosurgery.  2007; 43:222-235.
Young adult who presents with neck pain, weakness, and numbness in Right Arm.
History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sir Victor Horsley
History  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Outcome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intramedullary Spinal Cord Metastases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intramedullary Spinal Cord Metastases Costigan DA, Winkelman MD. Intramedullary spinal cord metastasis. A clinicopathologic study of 13 cases. J Neurosurg 1985;62:227-33.
Intramedullary Spinal Cord Metastases: Clinical Manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Schiff D, et al. Intramedullary spinal cord metastases: Clinical features and treatment outcome.  Neurology.  1996; 906-912.
Intramedullary Spinal Cord Metastases (Contributed by Dr. Marc D Winkelman.)
Intramedullary Spinal Cord Metastases (Contributed by Dr. Marc D Winkelman.)
Intramedullary Spinal Cord Metastases (Contributed by Dr. Marc D Winkelman.)
Intramedullary Spinal Cord Metastases (Contributed by Dr. Marc D Winkelman.)
Initial Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Adenocarcinoma of the Colon  Grasso G. Intramedullary spinal cord tumor presenting as the initial manifestation of metastatic colon cancer: case report and review of the literature.  Spinal Cord. 2007; 45: 793-6.
Presentation ,[object Object],[object Object],[object Object],[object Object],Schiff D, et al. Intramedullary spinal cord metastases: Clinical features and treatment outcome.  Neurology.  1996; 906-912.
Theories ,[object Object],[object Object],[object Object]
Spinal Cord Anatomy: Vasculature ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Drop Metastases  (Contributed by Dr. Marc D Winkelman.)
Drop Metastases (Contributed by Dr. Marc D Winkelman.)
Intramedullary vs. Epidural ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intramedullary Metastasis  vs. Radiation Myelopathy  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prognosis & Complications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Management ,[object Object],[object Object],[object Object],[object Object],[object Object]
Paraplegia Complications?  ,[object Object],[object Object],[object Object],[object Object]
Intramedullary Spinal Cord Metastases 2 months following therapy Schiff D, et al. Intramedullary spinal cord metastases: Clinical features and treatment outcome.  Neurology.  1996; 906-912.
Intramedullary Spinal Cord Metastases Schiff D, et al. Intramedullary spinal cord metastases: Clinical features and treatment outcome.  Neurology.  1996; 906-912.
Multiple Metastases ,[object Object],[object Object],[object Object],[object Object],[object Object]
Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object]
Adult Primary Intramedullary Spinal Cord Tumors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pre-operative Presentation of Adult  Intramedullary Spinal Cord Tumors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Manzano G, et al. Contemporary management of adult intramedullary spinal tumors- pathology and neurologic outcomes related to surgical resection.  Spinal Cord.  2008; 46:540-6.
Adult Primary Intramedullary Spinal Cord Tumors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hemangioblastoma ,[object Object],[object Object],[object Object],[object Object]
Hemangioblastoma Kothbauer KF. Neurosurgical Management of Intramedullary Spinal Cord Tumors in Children.  Pediatric Neurosurgery.  2007; 43:222-235.
Hemangioblastoma Francavilla, Thomas. Intramedullary Spinal Cord Tumors.  http://www.emedicine.com/med/topic2995.htm   Accessed  September 13, 2008 . Conus medullaris lesion in a 45-year-old man who presented with midline back pain.
Prognosis: Adult Primary Intramedullary  Spinal Cord Tumors  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Astrocytoma Francavilla, Thomas. Intramedullary Spinal Cord Tumors.  http://www.emedicine.com/med/topic2995.htm   Accessed  September 13, 2008. This 18-year-old woman presented with poor balance and a staggering gait progressing over 1 year.  4-year follow-up
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