Cns Tumors Spinal Cord

Epidemiology

  • 1.1 case per 100,000 persons.
  • 15-20% of all central nervous system (CNS) tumors
  • occur anywhere from the cervicomedullary junction to the filum terminale.
  • 50% present in the thoracic cord, primarily because of the relative size of this area.
  • Ependymomas make up 60% of primary sinal cord tumors

Incidence by Age and Location

  • Adults
    • Extradural 78%
    • Intradural 18%
    • Intramedullary 4%
  • Pediatric
    • Extradural 18%
    • Intradural 64%
    • Intramedullary 18%

Anatomy of Spinal Cord

Spinal Cord Layers from outside in is composed of

  • Extradural (outside of the dura mater)
  • Intradural (inside dura mater)
    • Extramedullary (inside dura mater but outside pia mater)
    • contains cerebral spinal fluid as well as nerve roots and ganglions
    • Intramedullary (inside pia mater)
  • Top of the spinal cord
  • Bottom of the spinal cord
    • Spinal Cord (intramedullary) ends at Conus Medullaris at around T12-L1
    • The meninges around the spinal cord as well as the cauda equina ends at filum terminale around S2

Histology by Location

  • Extradural Tumors
    • most all extradural tumors are metastatic tumor
  • Intradural Tumors
    • Extramedullary
    • more common than intramedullary
    • Schwannoma and meningioma are most common
    • Intramedullary
    • 40% are Ependymomas
    • Astrocytomas and ependymomas are most common

Location of Different Histologies

  • Schwannoma found most commonly in the thoracic spine
  • Meningiomas are found at foramen magnum and thoracic spine
  • Astrocytomas are distributed throughout the spinal cord
  • Ependymomas involve the conus medullaris and cauda equina
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