الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Primary Spinal cord tumors are herogenous rare group of tumors that represent 15% of CNS tumors. They may be intradural extramedullary or intradural intramedullary and some of these tumors mey extend to the extradural space. Among these tumors intradural extramedullary tumors are more common. Meningioma, nerve sheath tumors, ependymoma and astrocytoma are the commonest.
Intramedullary spinal cord tumors have no typical clinical presentation, but most adult patients present with complaints of back or radicular pain or parethesias. Children present with scoliosis or neurologic complaints. Almost all patients with extramedullary tumors have pain, which most commonly has a radicular distribution. The number of patients with mild motor deficits at presentation is high, but only a minority is severely impaired.
There are several lesions that can mimic intradural neoplasms such as vascular malformation (i.e. cavernous hemangioma and dural arteriovenous fistula), tumefactive multiple sclerosis (MS), transverse myelitis, cord contusion and cord infarction, degenerative disk disease, polyneuropathy, infections and extradural spinal axis tumors.
The imaging modality of choice for the evaluation of intradural spinal tumors is MRI. In general several phased-array spine coils should be used simultaneously to obtain a large field of view. The imaging protocol should include sagittal and axial T1-weighted and T2-weighted sequences including contrast-enhanced sagittal and axial T1-weighted sequences and if needed also coronal images.
Plain films are still routinely performed: abnormal findings in adults include mainly straightening of the spine with disappearance of the normal curvatures, Progressive scoliosis, Widening of the spinal canal occurs in children but not in adults. Computed tomography may show widening of the canal as well when present. Plain CT should not be chosen as a screening modality for intraspinal lesions as visualization of the canalar content is still limited. Myelography isn’t used nowadays due exacerbation of symptoms. Angiography is used in diagnosis of some cases. However biopsy is the surest method of diagnosis.
Despite their rarity, there is an extensive literature on the management of these tumors. Over the past 30 years, the approach towards management of these tumors has become more aggressive in an attempt to preserve or improve neurological function; however, the role of adjuvant therapy remains unclear. Surgical resection remains the treatment of choice for extramedullary tumors. Some authors contend that great effort should be made to follow and resect all extradural components in order to reduce recurrence Microsurgical techniques were employed as standard and instrumentation was not used. The operative aim in all cases was to attempt complete excision but this was not always achievable due to indistinct tumors margins, or when surgery would result in destabilization of the spinal column.
The microscope and microsurgery have revolutionized all neurosurgery and also opened the door to innovation in the treatment of spinal cord tumors. MRI has dramatically improved pre-operative planning and significantly contributed to the development of modern treatment strategies.
Intraoperative monitoring of evoked potentials is a standard monitoring tool for the surgical treatment of the spinal cord lesions. Both sensory and motor evoked potentials monitoring are used to assess the functional integrity of the spinal cord during surgical procedures.
Surgery should be carried out before significant neurological deterioration occur the better functional grade before surgery the greater likelihood of functional return after surgery.
New trends like gene therapy are still under investigations but they carry a great hope for future treatment of these tumors.
Once neurological deficit has been developed neurological functions willn’t be regained again. Most of these tumors are benign and have a good prognosis but some of them may turn malignant. Some of these tumors may also recure especially astrocytoma and disseminated ependymoma.