Intramedullary Spinal Cord Tumors

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

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],[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]

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.

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.)

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]

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

Intramedullary Spinal Cord Tumors

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Intramedullary Spinal Cord Tumors