13 - Spinal tumours

Summary

Introduction

Spinal tumours may be classified as extradural or intradural. Intradural may be divided into extramedullary and intramedullary. The true incidence of spinal cord tumours is unknown and should be reviewed in the light of modern neuroradiological diagnosis. Estimates based on population studies vary from 1 to 13 per 100 000 population (Connolly 1982). In this chapter, intradural tumours are described first. Clinical signs, diagnosis and treatment are reviewed according to the modern literature.

Intradural tumours

Extramedullary tumours

Incidence and clinical signs

About 70% of intradural tumours are extramedullary, the majority being meningiomas or schwannomas (Foy 1992). Pain of spinal root origin is the commonest initial symptom, occurring mostly at night; it may precede by months or years the signs of spinal cord compression. Motor disturbances are often the second symptom to be noticed involving the legs first, with spasticiry and increased reflexes. Sensory deficits nearly always appear after the motor disturbances. At the beginning, a sensory level due to cord compression will not correspond with the true site of the tumour. Sphincter disturbances always occur at a late stage.

Meningiomas Cushing & Eisenhardt (1938) gave an informative description of these tumours, which account for approximately 25% of spinal cord tumours. They occur predominantly in women. They are encountered most frequently in patients between the ages of 40 and 70 years. Meningiomas may develop in any part of the spinal canal but arise most frequently in the thoracic region, then the cervical area and rarely in the lumbosacral canal (Nittner 1976).