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Spine and Spinal Cord Tumors

"Spinal cord tumors, while rare, can leave patients with catastrophic neurological impairment."

(A Patient Information Service)

Spinal Cord Tumors and Tumors of the Bone of the Spinal Column are an area of specific interest for Dr. Martin L. Lazar and the staff of Neurosurgical Consultants. Their successful treatment in most cases of Intraspinal Tumors involves the use of highly advanced Minimally Invasive Microsurgical Techniques. The majority of these patients undergo a UNILATERAL (one-sided) APPROACH. This revolutionary concept in Neurosurgery greatly limits the amount of surgical exposure required and therefore limits the amount of tissue (including the muscles of the spine) that are touched and retracted during the operation. This results in less post-operative pain, earlier mobilization, diminished hospital stay, less risk for complications, an earlier return to activities as well as lower overall costs.

The following information is provided as part of Neurosurgical Consultants' Patient Information Program.

Spinal Anatomy and Spinal Tumors

Spinal tumors are usually classified by their relationship to the spinal cord and its coverings. The spine is composed of individual bones (Vertebrae) stacked one on top of the other in a column. Each vertebra consists of an oval shaped vertebral body, which lies in the front (anterior) part of the vertebra. The vertebral body is the major weight bearing portion of the vertebra. The back (posterior) portion to the vertebra consists of an arch of bone (Lamina and Spinous process), which protect the spinal cord and its coverings. The bony arch of each vertebra is connected to the body by two small columns of bone (Pedicles). The Spinal Canal (the circular center portion of the vertebra) is formed by the two (2) Lamina on either side in the back, the pedicles on both sides and the vertebral body in the front. The spinal cord and its nerve roots are contained within the spinal canal and are covered by a fibrous tubular membrane called "Dura Mater".

One convenient way to understand this anatomy is to consider that the Spinal Cord and Spinal Nerves live within a "house made of bone" (the Spinal Canal). The "roof" of the house is formed by the Lamina. The "walls" are formed by the Pedicles and the "basement" by the Vertebral Body. A pair of Spinal Nerves will exit the Spinal Canal at every vertebral level through "windows" in the "walls" which are formed by the pedicles of adjacent vertebrae.

Tumors that are located within the Spinal Canal and outside the Dura Mater are called Intraspinal Extradural Tumors. Most of these are metastatic tumors (cancerous tumors which have spread from another organ), which arise within the vertebrae themselves. Tumors arising inside the dura mater, but outside the actual substance of the spinal cord are termed Intradural-Extramedullary Tumors. The majority of these tumors are Neurofibromas (nerve sheath tumors) or Meningiomas. Tumors arising within the substance of the spinal cord itself are called Intramedullary Tumors. These are usually Astrocytomas or Ependymomas.

It is important to understand that different types of tumors often behave differently and may require treatments that are specific to the characteristics of that tumor. Details of these various types of tumors are explained in more detail in the following material.

Spine Tumor Facts

General:

  • Spinal cord tumors are less common than brain tumors. About 10,000 Americans develop primary spinal cord or metastatic spine tumors each year.
  • Although spinal cord tumors affect people of all ages, they are most common in young and middle-aged adults. (National Institute of Neurological Disorders and Stroke)
  • Spinal cord tumors, while rare, can leave patients severely impaired neurologically. Modern neuroimaging capabilities (such as MRI and CT Scanning) have allowed these lesions to be diagnosed earlier thus permitting more timely intervention.
  • Advanced Minimally Invasive Microsurgical Techniques and other specialized treatments can help to minimize the effects of these potentially devastating types of tumors.

Primary Spinal Cord Tumors:

  • These are tumors that derive from cells within the spine/spinal cord
  • 90 percent of primary spinal cord tumors are BENIGN.
  • The most common primary spinal cord tumors are Intradural Extra-medullary (located within the covering of the spinal cord, the Dura Mater, but outside the substance of the spinal cord itself.) The most common of these are Meningiomas, Neurofibromas and Schwannomas.
  • The majority of these tumors are slow growing, although some spinal cord tumors can grow rapidly.
  • Malignant primary central nervous system (Brain & Spinal Cord) tumors rarely spread out to other body parts although some can "seed" themselves within the Cerebrospinal Fluid pathway that surrounds the brain and spinal cord. (National Institute of Neurological Disorders and Stroke)
  • Men & women are affected equally by benign spinal cord tumors except for Meningiomas which disproportionately affect more women.
  • The THORACIC region of the spine is involved more frequently than the CERVICAL region by these tumors. The LUMBO-SACRAL region is the least affected.
Primary Tumors That Originate In or Near the Spinal Cord
Type of Tumor Origin Cancer Status People Affected
Astrocytoma Cells of the tissue that supports nerve cells Cancerous or noncancerous Children and adults
Ependymoma Cells lining the canal in the center of the spinal cord Noncancerous Children and adults
Hemangioblastoma Blood vessel cells Noncancerous Children and adults
Meningioma Cells of the layers of tissue covering the spinal cord (meninges) Noncancerous but may recur Children and adults
Neurofibroma Cells that support peripheral nerves Usually noncancerous Children and adults (occurs in neurofibromatosis)
Sarcoma Cells of connective tissue in the spine Cancerous Children and adults
Schwannoma Cells that form the myelin sheath around nerve fibers (Schwann cells) Usually noncancerous Children and adults

Metastatic Spine Tumors:

  • Malignant tumor cells arising elsewhere in the body can easily spread (metastasize) to within the substance of the brain and the bone of the spinal column; however, they rarely spread to the substance of the spinal cord itself.
  • Metastatic Spine tumors occur in 10 percent of cancer patients.
  • For every four people who have cancer that has spread somewhere within the body, one also develops metastasis within the central nervous system. The two most common metastatic tumors to the Brain and Spine are from lung and breast cancers. (National Institute of Neurological Disorders and Stroke)
  • Ten (10) percent of cancer patients with metastatic tumors to the spine have NO PREVIOUS KNOWN CANCER and of these, spinal cord compression and pain are the first signs & symptoms of the disease.

Vertebral Column Tumors:

Spinal bone tumors involve the bony vertebral column and can be divided into cancerous tumors and benign tumors.  Cancerous spinal bone tumors include metastatic cancers and primary bone cancers.   Although any type of cancer can spread to spinal bones, the most common ones are cancers of lung, breast, prostate and kidney as well as lymphomas.

Treatment

Metastatic cancer is usually impossible to "cure". However, surgical debulking of the tumor (with or without mechanical spine stabilization) in order to remove any pressure on the spinal cord, can improve quality of life. Operative therapy may also consist of placement of acrylic material or banked bone and metallic implants to preserve the stability of the spine, following removal of the portion of the vertebra involved with tumor. For metastatic tumors which do not compress the spinal cord or destabilize the spine, radiation therapy often significantly reduces spinal pain. The technical advances in STEREOTACTIC RADIOSURGERY have particular relevance for radiation of the spine by diminishing the risk of damage to the spinal cord (http://www.cksociety.org/).

Primary cancerous spinal bone tumors are relatively uncommon and include chordomas, osteogenic sarcomas, chondrosarcomas, Ewing's sarcomas, multiple myelomas, lymphomas etc.   Treatments for these malignant tumors must involve multimodality measures which, includes surgery, chemotherapy and radiation.

Benign spinal bone tumors include osteoid osteomas, osteoblastomas, osteochondromas, giant cell tumors, aneurysmal bone cysts, plasmacytomas, hemangiomas, etc.  Treatments for these benign tumors must be individualized depending on the type of pathology and their symptoms. Benign tumors of the spinal column can often be totally removed.

Intradural-Extramedullary Tumors:

Meningiomas and nerve sheath tumors (Schwannomas and Neurofibromas) comprise the overwhelming majority of this subset of spinal tumors. Meningiomas arise from the arachnoid (a thin covering layer of the spinal cord which is located inside the dura) and are most common in middle aged and elderly women. The Thoracic portion of the vertebral column is the most commonly affected part of the spine. Schwannomas and Neurofibromas arise from the nerve roots which come off the spinal cord. Neurofibromas can occur as a sporadic condition or as a genetic disorder such as Neurofibromatosis http://www.nfinc.org/.

Meningiomas, Neurofibromas and Schwannomas are almost always entirely histologically benign. There are some additional, although exceptionally rare, tumors that are included in this group of benign tumors such as Hemangioblastomas, Epidermoids and Dermoids.

Treatment

All of these tumors are considered to be benign and most can be successfully removed surgically using advanced Minimally Invasive Microsurgical Techniques.

Intramedullary Tumors:

General Comments

The three most common types of intramedullary spinal cord tumors are low-grade astrocytomas, ependymomas, and high-grade astrocytomas.

Astrocytomas and Ependymomas account for the majority and occur with about equal frequency. Hemangioblastomas are less common and sometimes occur in conjunction with Von Hippel Lindau disease (a disease in which patients are prone to developing cysts in the kidney and other organs http://www.vhl.org). Intramedullary tumors occur most often in the cervical spinal cord and are often relatively benign.

Glioma

These tumors usually arise, within the substance of the spinal cord itself, from cells known as "GLIAL CELLS". This series of cells comprises the "glue" or structural "support" 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 comprise 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.

Tumor Grade

Tumor grading is important for prognosis and therapy. Tumors are graded by microscopic examination of the tumor specimen. The specimen is evaluated for the most malignant components. Varying "grades" of tumor cells can be found in any one tumor. The biological behaviour of the tumor will relate to the highest grade (worst and most aggressive) component of that tumor, even though that higher grade component comprises a small portion of the entire tumor. In other words, if a tumor is 99.5% Grade 1 and only 1/2 percent Grade 3 or 4, the biological behaviour of that tumor, will be as if the entire tumor is Grade 3 or Grade 4.

Symptoms

These tumors can be difficult to diagnose early in the course of the disease process, since the clinical features of intramedullary spinal cord tumors are variable. Early symptoms are usually nonspecific and may only subtly progress. Symptom duration before diagnosis is often 2 to 3 years, whereas malignant or metastatic neoplasms cause problems within a much shorter course, usually in several weeks to a few months.

Pain is the most common presenting symptom of intramedullary spinal cord tumors in adults. The pain typically localizes to the level of the tumor. Sensory or motor (weakness and spasticity) complaints are the initial symptoms in up to one third of patients. Upper extremity symptoms predominate in cases of cervical neoplasms. One sided or asymmetrical involvement is common. Thoracic cord tumors produce spasticity and sensory changes. Numbness is a common complaint and usually begins in the more peripheral locations of the lower extremities. Tumors of the lumbar region and conus medullaris present with back and leg pain. Bladder and bowel dysfunction tends to occur early.

A careful history and physical examination is the first step in diagnosis. MRI scanning without and with contrast agent (Gadolinium) is the primary method to diagnose these tumors. MRI generally offers excellent anatomical details regarding the position of the tumor and its relationship to the spinal cord.

TUMOR TYPES

EPENDYMOMA

Ependymomas are tumors that arise from Ependymal cells, which make up the thin layer of epithelium that lines the central canal of the spinal cord. Ependymal cells are the third type of cell in the "glial" cell series, the others being Astrocytes and Oligodendrocytes. In a manner similar to other "Gliomas", Ependymal Cells can form a tumor called "Ependymoma". These tumors comprise approximately 60% of spinal cord gliomas, 96% occur in adults.

Ependymomas have the potential to spread ("seed") through the CSF (Cerebrospinal Fluid that surrounds the cord) pathway to other areas of the nervous system.

Ependymomas can spread (a process called "seeding") to other regions of the spinal cord through the spinal fluid. There are a number of varieties of ependymoma recognized by the World Health Organization.

The papillary ependymoma (the most common) occurs in the brain and spinal cord, while the myxopapillary ependymoma occurs only at the bottom of the spine.

The subependymoma is a common finding at autopsy and a rare cause of surgical intervention. Finally there is the anaplastic ependymoma, a more aggressive tumor.

Intramedullary Ependymoma

These are tumors that arise from ependymal cells within the substance of the spinal cord and are the most common intramedullary tumor in adults. These tumors, which affect men and women equally, occur throughout life, but are more frequently seen in the middle adult years.

Spinal Cord Ependymoma is more likely to occur in the thoraco-lumbar junction region and involve the "Cauda Equina". The most common presenting complaint is that of "PAIN". Weakness and/or tingling in the lower extremities, bowel and bladder control may also be noted. MRI scan is the most effective diagnostic screening method and is often done when the tentative diagnosis is thought to be a herniated lumbar disc.

Treatment

Surgery

Treatment demands surgical excision to the maximum extent possible. Minimally invasive microendoscopic spinal cord removal techniques are now available. Nevertheless, not all tumors can be entirely removed. For those where some residual is known, or believed to be present, then radiation and chemotherapy should be serious considerations.

The Neurosurgeons of Neurosurgical Consultants have a particular interest in and significant experience with Spinal Cord Ependymomas.

Radiation Therapy

Ependymomas rank second only to Medulloblastomas in sensitivity to radiation. Radiation Therapy is administered after surgical excision to the tumor bed and if any metastases ("SEEDING") through the CSF are found. In 50% of patients survival time was 2 years longer with radiation therapy than without.

The overall 5-year survival rate is 45%. Tumor recurrence or progression at the primary site is by far the most common cause of death in these patients. Spinal seeding is relatively uncommon and occurs later in the course of the disease for most patients.

Filum Terminale Ependymoma

These tumors differ from other ependymomas by their location within the Filum Terminale, a neurologically non-functioning structure at the lower-most end of the spinal cord.

Treatment

Surgery

The role of surgery for Filum Terminale Ependymomas depends on the size of the tumor and its relationship to the surrounding roots of the cauda equina. We strongly favor Minimally Invasive Microsurgical Gross Total Resection when possible. Complete surgical resection can be accomplished with small and moderate-sized tumors that remain well circumscribed within the fibrous coverings of the Filum Terminale and are separable from the cauda equina nerve roots. Large tumors can present significant problems for surgical resection. These tumors have been present for many years and present a risk for spread through the cerebrospinal fluid. Filum Terminale Ependymomas that are large and adherent to many nerves can make total removal difficult to impossible without considerable damage to the nerve roots to which they are densely adherent. While many can be safely and completely resected, those that cannot and should not be totally resected, can be treated with post-operative radiation therapy and chemotherapy.

Even in cases where the tumor can be removed totally, a recurrence rate of at least 20% can be anticipated.

Radiation Therapy

Biologically aggressive tumors, which are more common in younger patients, can recur early after removal. Radiation therapy is an important adjunct for these patients as well as those in whom a significant amount of tumor is left behind during the operation.

Chemotherapy

Neuro-oncologic chemotherapy, an option available in some centers, is the third arm of a comprehensive effort to prolong and maintain a high quality of life.

Traditional management has been to use "standard" forms of chemotherapy. Currently there are some unconventional chemotherapeutic alternatives that offer considerable hope for improved quality and length of survival. New therapies such as Temodar (temozolamide), Avastin (bevacizumab which is an anti-angiogenesis medication) and CPT-11 are currently being used by one of our Neuro-oncologists either alone (or more commonly) in combination or with other drugs, to produce encouraging results.

ASTROCYTOMA

These are tumors that arise from cells called Astrocytes, which are normally found within the substance of the 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 neoplasms in adolescents. Almost 60% of these tumors are located in the cervical and cervicothoracic spinal cord segments. The thoracic, lumbar, or conus medullaris locations are less common.

Spinal Cord Astrocytomas represent a mixed group with respect to histology, gross characteristics, biology, and natural history. They range from benign to malignant. These tumors include low-grade fibrillary and pilocytic astrocytomas, malignant astrocytomas, glioblastomas, gangliogliomas, and the rare oligodendroglioma. Approximately 25% of adult astrocytomas are malignant.

The borderline between low-grade and Anaplastic (Malignant) Astrocytoma, is at best indistinct. Although many patients with low-grade Astrocytomas survive for extended periods, 50% of surgically treated lesions evolve into Anaplastic Astrocytomas or Glioblastomas. Degeneration into a higher-grade neoplasm is the most common cause of death in patients with low-grade Astrocytomas.

Low-grade Astrocytomas

Low-grade Astrocytomas are uncommon tumors and occur less frequently than their more malignant counterparts. They are generally found in a younger population and have a more favorable prognosis. Their true incidence is difficult to determine, because sampling and grading vary substantially. Low-grade Astrocytoma probably represents 10% to 15% of gliomas. These are neoplasms of children and adults from 20 to 40 years of age. These tumors are rare in older adults. Low-grade Astrocytomas can present with any of the symptoms previously described.

Anaplastic Astrocytomas

Anaplastic Astrocytomas are among the most common primary malignant spinal cord tumors. These tumors represent approximately one third of all Astrocytomas and about one quarter of all gliomas. They occur at any age but typically are found in older patients. Their peak incidence is in the fifth and sixth decades of life.

Malignant Astrocytomas generally have a poor prognosis, with an average survival of two (2) years. Both types of malignant Glial tumors (Anaplastic Astrocytomas and Glioblastomas) spread through the extracellular space and along the compact white matter tracts that travel through the spinal cord.

Glioblastoma Multiforme (GBM)

GBMs are the most common and most malignant of the primary CNS neoplasms, representing 15% to 20% of these tumors. Approximately half of all Astrocytomas are GBMs.

GBMs usually occur in patients over 50 and are unusual in patients under 30. Like Anaplastic Astrocytomas, GBMs can occasionally be found at any age.

Along with primary CNS Lymphoma, GBMs have the worst prognosis of all primary tumors. GBMs disseminate early, rapidly, and widely. Central Nervous System spread is common, but distant metastasis is rare.

Oligodendrogliomas (Oligo)

Oligodendrogliomas are uncommon gliomas. These tumors arise from glial cells, called Oligodendrocytes (the cells that are responsible for creating and maintaining myelin, which is the insulating substance around the axons of spinal cord fibre networks). They are much less common than Astrocytes. These are tumors of adults, with the peak incidence being between 35 and 45 years of age.

It is important to recognize that a significant percentage of Astrocytoma tumors may also have an Oligodendroglioma component as well. These tumors are called "Mixed Gliomas". Treatment of a Mixed Glioma is similar to what is described for an Astrocytoma.

Most Oligodendrogliomas are slow-growing tumors. Tumor grade is the single most important prognostic variable.

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.

Treatment

Surgery

Surgery is the most effective treatment for most intramedullary spinal cord tumors. The goal 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 or in any tumor where there is a clear demarcation/interface 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.

It is imperative to understand that Astrocytomas are "infiltrative", and as such, their nature is to spread along the interconnecting fiber pathways (tracts) of the spinal cord. Therefore, it is unlikely that surgery will ever be the definitive treatment for many of these neoplasms.

Aggressive surgical excision of the tumor is advocated in most patients. The goal is to reduce the maximum amount of the tumor. When tumor is within the substance of the spinal cord, an aggressive internal decompression of the tumor is warranted. There are some advanced technologies that currently assist in the extent of resection. The ability of the surgeon to "visualize" tumor is somewhat limited. Magnification of vision, Intraoperative ultrasound imaging, and Intraoperative Fluorescence techniques are a few of the adjunctive technologies that may be available to assist maximum resection, while limiting the risk of injuring adjacent functioning spinal cord.

The surgeon may choose to reserve a small part of the tumor for tissue culture and sensitivity testing against various chemotherapeutic agents. It can be helpful to know beforehand, if a certain drug has any or limited effectiveness against this particular tumor, in this particular patient.

In selecting the treatment of High Grade Malignant Astrocytomas, it should be kept in mind that the following three (3) statistically independent factors affect the length of survival: 1) age at the time of diagnosis, 2) histological features (Grade of the tumor and additional characteristics such as Mitotic Index), and 3) performance status (the level of the patient's neurological capabilities). Older patients with high grade malignant spinal cord tumors, who are in poor neurological condition at the time of surgery, do less well.

Tumors that cannot be totally resected, or are recognized to be more aggressive, will require post-operative radiation therapy and possibly chemotherapy as well. 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.

Radiation Therapy

Radiation therapy continues to have an important place in the treatment of many of these tumors and will be the second major treatment option, in a comprehensive therapeutic program, for most patients.

Radiation therapy is the primary form of non-surgical treatment. It is rarely administered to the whole spinal cord; newer forms of Radiosurgery (Focused Beam Radiation) allow for very precise focusing of radiation beams into the area of tumor involvement, with less risk for damage to the surrounding spinal cord. Radiosurgery (Focused Beam Radiation) has made this spinal cord radiation treatment less toxic than in previous years. This exceptionally accurate radiation therapy system may someday be useful in the management of intradural extramedullary as well as intramedullary spinal cord tumors.

Consideration to WITHOLD radiation therapy may be appropriate in cases of gross total surgical removal, or incomplete removal, or in some cases of low grade Astrocytoma. Meticulous follow up is required, since radiation therapy can be helpful where tumor recurrence or progression is documented.

Chemotherapy

Chemotherapy is the third arm of this comprehensive effort to prolong and maintain a high quality of life.

Traditional management has been to use "standard" forms of chemotherapy. Currently there are some unconventional chemotherapeutic alternatives that offer considerable hope for improved quality and length of survival. New therapies such as Temodar (temozolamide), Avastin (bevacizumab which is an anti-angiogenesis medication) and CPT-11 are currently being used by one of our Neuro-oncologists either alone (or more commonly) in combination or with other drugs, to produce encouraging results.

Additional information regarding these treatments is available at the "Virtual Trials" website.

COMPREHENSIVE THERAPY

Patients suffering from spinal cord tumors often require extensive and prolonged medical care, which involves a large multidisciplinary team comprising medical, surgical, neuroradiological, radiotherapy, neuro-oncological and rehabilitation specialists.

This team of specialists, involved in comprehensive programs, are  an important factor in the successful management of patients with spinal cord tumors.

Ultimately we hope to see the availability of specific gene therapies to treat tumors of the spinal cord such as Astrocytomas and other Primary Central Nervous System Tumors.

Illustrated Cases

Several patients with Spinal Cord Tumors are presented to illustrate the differences in these clinical problems. An example of a complete resection of a Filum Terminale Ependymoma is contrasted with another case in order to demonstrate the issue of dense adherence to nerve roots, which limits the reasonable possibility of complete respectability.

Patients with Spinal Cord Meningioma and Neurofibroma are included as well.

A. Filum Terminale Ependymoma

Case 1. Jeremy Lugan is a 19 year old male with a three (3) month history of lower back and right hip, groin and flank pain. Jeremy's neurological examination was negative for any deficits. MRI demonstrated an ovoid "enhancing" intradural mass lesion. (INSERT MRI scans AP & LATERAL views)

A complete resection of a Filum Terminale Ependymoma was accomplished. Jeremy is free of any neurological deficits. (INSERT SURGICAL PHOTOS/VIDEO)

Case 2. Gregory Dunkle is a 38 year old male with a 4 year history of lower back pain. He had diminished pin prick sensation in his feet on both sides. MRI scan showed an ovoid intradural "enhancing" mass at the L2 and L3 levels. There was a smaller "enhancing" lesion 2 vertebral segments below the larger one. (INSERT MRI scans AP & LATERAL views)

The surgery consisted of a Minimally Invasive Microsurgical Bilateral L2 and L3 Laminectomy using a Unilateral (one sided) Approach. The tumor proved to be a Myxopapillary Ependymoma. The tumor "invaded" the pia arachnoid (the membrane directly adherent to the nerve root) of many nerve roots making a complete and total resection impossible, without sacrificing the major nerve roots. The vast majority (over 98 per cent) of the large tumor was removed. Subsequent radiation therapy (to include the smaller more distal "seeded" tumor as well) and chemotherapy has been well tolerated. (INSERT SURGICAL PHOTOS/VIDEO)

B. Meningioma Johnnie Myrick-Haynes is a 63 year old female with an 8 year history of progressive weakness of her lower extremities, leading to her inability to walk (spastic paraparesis) and sensory impairment to the T8 (Thoracic) level. MRI and CT scans demonstrated a partially calcified, intradural tumor exerting considerable pressure upon and displacing the spinal cord at the T8 level. The calcification lay in the anterior (front) part of the spinal canal and tumor. The presence of this calcification (bone) is a known occurrence in meningiomas. Nevertheless, this rock hard lesion makes resection a formidable challenge. (INSERT MRI and CT scans AP & LATERAL views)

A Minimally Invasive Microsurgical Costo-transversectomy (removal of the head of a rib and the transverse process of the vertebra to which the rib attaches) and Bilateral Laminectomy at T7 and T8 was carried out using a Unilateral (one sided) Approach. A complete resection of the calcified Meningioma was accomplished. Mrs. Myrick-Haynes noticed improvement in leg function shortly after surgery. She began to walk several days post-operatively and continues to enjoy steady improvement to unassisted walking. (INSERT SURGICAL PHOTOS/VIDEO)

C. Neurofibroma

Mr. Irvin Harbour is a 61 year old male CT scan technician with a 6 month history of lower back and bilateral leg pain. An MRI scan demonstrated an ovoid "enhancing" mass at the L1 (Lumbar) level. (INSERT MRI scans AP & LATERAL views)

The surgical approach consisted of a Minimally Invasive Microsurgical Bilateral L1 and L2 Laminectomy using a Unilateral Approach. Complete resection of a large Neurofibroma embedded within the Cauda Equina (nerve roots) was carried out. Mr. Harbour was mobilized within a short period of time post-operatively and went home on the second post-operative day. (INSERT SURGICAL PHOTOS/VIDEO)

Messrs. Lugan, Dunkle and Harbour and Ms. Myrick-Haynes' results are usual of these types of operation. Each patient's recovery differs and depends on many factors. Age, sex, type and amount of disability and length of symptoms all play a role in the recovery process. Our treatment goal in all cases is to allow the patient to resume all the activities they did prior to their injury whenever possible.

There are two (2) general "guidelines" regarding recovery of neurological function:

  1. Recovery is less likely to be complete in the older patient, patients in whom the symptoms & signs have been present for extended periods of time and the neurological deficits are more severe.

  2. Whatever neurological deficits remain at a point one (1) year after surgical treatment are most likely to be permanent.

* Mrs. Myrick-Haynes and Messrs. Dunkle, Harbour and Lujan have signed a release to permit the sharing of this personal information. We will not disclose any information unless the parties involved agree in writing. Mrs. Myrick-Haynes and Mr. Harbour chose to permit this information because of their gratitude to Dr. Martin L. Lazar and his staff.

DISCLAIMER:

Every effort has been made by the author(s) to provide accurate, up-to-date information. However, the medical knowledge base is dynamic and errors can occur. By using the information contained herein, the viewer willingly assumes all risks in connection with such use. Neither the author nor Neurosurgical Consultants, p.a. shall be held responsible for errors, omissions in information herein nor liable for any special, consequential, or exemplary damages resulting, in whole or in part, from any viewer(s)' use of or reliance upon, this material.

CLINICAL DISCLAIMER:

Clinical information is provided for educational purposes and not as a medical or professional service. Person(s) who are not medical professionals should have clinical information reviewed and interpreted or applied only by the appropriate health professional(s).

For additional information or to have your Spinal Cord Tumor reviewed, please contact our office.


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This page last edited on 2/20

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