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ASTROCYTOMA

These are tumors that arise from cells called Astrocytes, which are normally found within the substance of the Brain and Spinal Cord. Approximately 3% of Central Nervous System Astrocytomas arise within the Spinal Cord. Spinal Cord Astrocytomas occur at any age, but are more common during the early years of life. They are by far the most common Intramedullary Spinal Cord tumor in children. They account for 90% of all Intramedullary Tumors in patients younger than 10 years of age and 60% of the Intramedullary Tumors in adolescents. Almost 60% of these tumors are located in the Cervical and Cervicothoracic Spinal Cord segments. The Thoracic, Lumbar and Conus Medullaris locations are less common.

Spinal Cord Astrocytomas represent a mixed group with respect to their natural history and histology. WE REGARD ALL OF THESE TUMORS AS BEING "MALIGNANT". Their biological behaviors range from Low-grade aggressiveness to Highly Malignant. These tumors include Low-grade Fibrillary and Pilocytic Astrocytomas, Anaplastic (or High-grade) Astrocytomas, Glioblastomas, Gangliogliomas, "Mixed Gliomas" and the rare Oligodendroglioma. Approximately 25% of adult Astrocytomas are High-grade Malignant Tumors.

GLIOMA: AN INTRODUCTION

The term "GLIOMA" refers to a "family" of tumors, which arise from cells known as "GLIAL CELLS". This series of cells comprises the "glue" cells of the Central Nervous System (CNS), in contradistinction to the "Neurons", which are the "action" cells of the Brain and Spinal Cord. Glial cells are the most common cellular component of the Brain. They are five to ten times more frequent than the trillion Brain Neurons and make up half the Central Nervous System (CNS) by volume.

There are three (3) different cell types in this cell series. The "Astrocyte" was so named, because it resembles the shape of a star, when looked at under a microscope. The next most common cell in this series is the "Ependymal Cell", which lines the cavities of the Brain (called Ventricles). These are normal chambers within the Brain, where Cerebrospinal Fluid (CSF) is manufactured. These cells are also found within the Central Canal (a small cavity) within the Spinal Cord. The last cell type is the "Oligodendrgogliocyte" ("Oligo"), which is the cell within the Brain and Spinal Cord responsible for making the insulating material (called Myelin), that surrounds the fibres (Axons) which transmit electrical impulses within the Brain and Spinal Cord.

Each of these cell types is capable of forming a tumor. The Neurosurgeons of Neurosurgical Consultants regard ALL OF THESE AS MALIGNANT TUMORS. The degree of malignancy, and therefore, biological aggressiveness can vary from quite indolent to extremely aggressive. These tumors are generally categorized according to their degree of aggressiveness, as judged by a number of factors. Neuropathologists (specialists trained to examine these tumors under powerful microscopes), have tended to "grade" these tumors from 1 to 4, with "4" being the most aggressive and "1" being the least malignant.

All of these tumors have a tendency to "infiltrate" within the Brain and/or Spinal Cord by tracking along the fibre pathways that interconnect every part of the Brain to every other part of the Brain. Very rarely do these tumors ever spread beyond the Brain or Spinal Cord.

DIAGNOSIS

Once again, MRI (without and with Gadolinium as a "contrast" agent) is the primary method to diagnose these tumors, since it affords diagnostic anatomical details including the position of the tumor and its relationship to the Spinal Cord.

Figure 1: MRI Scan (Sagittal View- Gadolinium enhanced) Medulla & Upper Cervical Spine

Extensive Cervical Spinal Cord "Mixed Glioma with a large Syrinx at the Cervico-Medullary Junction in a 41 year old lady with Neurofibromatosis.

MRI Scan (Sagittal View- Gadolinium enhanced). The Cystic (Curved Arrow) Brainstem lesion progressively enlarged resulting in severe Brainstem compression and neurological compromise.

This is a Gadolinium "enhancing" "Mixed Glioma" Tumor of the Brainstem and upper portion of the Cervical Spinal Cord ("white" area inside the Spinal Cord indicated by the Horizontal Arrows.)

Figure 2: MRI Scan (Transaxial View) Cystic Brainstem "Mixed Glioma" (Same Patient as Figure 1 & 3).

Note the thin remnant (Oblique Arrow) of the severely compressed Brainstem (represented by the dark "crescent-shaped" structure) that remains Anteriorly and Laterally as if it was draped around the Cyst (Curved Arrow.)

Figure 3: MRI Scan (Sagittal View)

Post-operative study following excision of the posterior wall and marsupialization of the Cyst (Curved Arrow.)

COMPARE this to the pre-operative MRI in Figure 1.

Focused Beam Radiosurgery and Chemotherapy followed the surgical treatment.

OPERATIVE VIDEOS OF THIS OPERATION ARE AVAILABLE ON THIS WEBSITE


TREATMENT

Surgery is the most effective treatment for most Intramedullary Spinal Cord Tumors. The role of surgery is determined primarily by the nature of the interface between the tumor and the Spinal Cord. Our strong preference favors Minimally Invasive Microsurgical Gross Total Removal of a benign tumor, if a clear demarcation/interface exists between the Tumor and the Spinal Cord. Surgical removal alone provides long-term tumor control or cure for Hemangioblastomas, almost all Ependymomas, and some well-circumscribed Astrocytomas.

Determination of the resectability of an intramedullary tumor is best made by direct intraoperative inspection of the Tumor-Spinal Cord interface.

Tumors that cannot be totally resected, or are recognized to be more aggressive (such as High-grade Astrocytomas), will require post-operative Radiation Therapy and possibly Chemotherapy as well.

PROGNOSIS

Long-term outcome and risk of recurrence depend primarily on tumor histology, the completeness of the original resection and responsiveness to Radiation and/or Chemotherapy.

FOLLOW-UP

Long-term follow-up (usually with MRI Scan) is required for ALL of these cases since RECURRENCE of any of these tumors remains as a possibility.



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This page last edited on 2/19

All content ©2016 by Neurosurgical Consultants, P.A.
Author, Martin L. Lazar, MD, FACS
All Rights Reserved. See Usage Notices.