Current management of intramedullary spinal cord tumors

Most intramedullary spinal cord tumors (IMSCT) are of glial origin and low-grade histology. Ependymomas are the most common tumor in adults; astrocytomas predominate in children. Symptoms progress slowly, and pain is the most common presenting complaint, although high-grade glial tumors produce a rapid progression of neurologic deficit. Magnetic resonance imaging (MRI) is the imaging study of choice, although nonneoplastic diseases capable of producing symptoms and/or lesions on MRI similar to IMSCTs include multiple sclerosis, syringomyelia, and sarcoidosis. The goals of surgical intervention are to provide tissue diagnosis, to preserve or improve neurologic function, and to provide total tumor removal. At surgery, ependymomas are well-circumscribed lesions and usually amenable to total resection, which is curative. Astrocytomas are infiltrating and generally cannot be completely resected. Low-grade astrocytomas have a poorer prognosis with regard to recurrence and functional outcome, although many patients enjoy long-term survival. Outcome for high-grade tumors is uniformly poor and early death is the rule.