Spinal Cord Tumors

Meningiomas or Meningiomas They cover 25% of spinal cord tumors located within the spinal cord membrane. It is one of the most common spinal cord tumors. 70% of the cases are women. Female:male ratios are 4:1 - 7:1 and it is more common in women. Although it can be seen at all ages, it is more common in the older age group. The most common age group is the 5th and 6th decades. It is more likely to be seen at the thoracic level in women. On the other hand, there is no specific location in the spinal canal in men. Trauma and genetic disorders such as NF2 are reported as causes. Meningiomas are very slow-growing and benign tumors that originate from the cap cells of the arachnoid, which is the membrane of the spinal cord, as well as in the brain. It is the second most common tumor among tumors that grow outside the spinal cord within the spinal cord. For every spinal cord meningioma, an average of 8 brain meningiomas are seen. G It often appears alone in the spinal cord. They can be seen more than once in 2% of cases. Spinal cord meningiomas in essence; They are tumors that show microscopic calcification, have a less vascular structure than brain meningiomas, are adherent to the spinal cord membrane, can be completely removed during surgery, and recurrence is very rare.

CLINICAL COURSE OF SPINAL CORD TUMORS MENINGIomas.

Patients' complaints and examination findings are important. Pain, numbness in the arms and legs, difficulty in walking, and urinary and stool problems may be observed. Patients often present with motor loss, although sensory loss is less common. Slowly progressive signs and symptoms of spinal cord compression, especially in middle-aged female patients, suggest meningioma. Pain radiating to the arm, back or leg is observed in 50-70% of patients. Again, problems in bladder and defecation may be observed in 50% of cases. The best results after surgery for meningiomas were obtained in patients with shorter clinical histories. Spinal meningiomas occurring in young patients may be more aggressive and have a worse prognosis.

DIAGNOSIS STUDIES OF SPINAL CORD MENINGIOMAS

The most important tool in the diagnosis of spinal meningiomas is magnetic resonance imaging. is patterning. On MRI, they appear iso-hypointense on T1 and T2 weighted images. It is absolutely necessary to have a medicated shot. They maintain homogeneous contrast except in areas of calcification. As in the central nervous system, the dural tail sign is the defining finding here. In order to detect extradural extension in computerized and MRI sections, it is necessary to take images in three planes. Unlike nerve sheath tumors, they do not cause bone changes or foraminal expansion.

LOCATION SITES OF SPINAL CORD MENINGIOMAS

In women; While 80% of these tumors are detected in the thoracic, 15% in the cervical and 5% in the lumbosacral region, in men, only half of these tumors occur in the thoracic region and 40% in the cervical region. They are usually located dorsal or lateral and grow by pushing the spinal cord. It originates from arachnoid villi cells embedded in the dura next to the nerve root. They are especially lateral and adherent to the dura. It may also originate from dural fibroblasts or pia, in which case it is located anteriorly or posteriorly. The prevalence is 85 percent in women and 80 percent in the thoracic region. The upper cervical region and foramen magnum are important locations. Although they are seen entirely within the dura, 10% are seen inside and outside the dura. It is most common in men, except for the spinal cord dura.

Locations of spinal cord meningiomas:

• Spine-Skull junction: 2%

• Neck: 14-18.5%

• Back: 75-82%

• Waist: 2-7%

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SPINAL CORD MENINGIOMAS SEEN IN YOUNG PATIENTS    

Spinal Cord meningiomas seen in young patients are mostly located in the neck region - the cervical region. Cervical location in young ages: 30-39%. Cervical meningiomas are mostly located anteriorly - in front of the spinal cord. In young people, spinal cord membrane – inside and outside the dura. Intra-extradural or extradural location and aggressive course are more common. Pathologically, angioblastic type is more common in young people.

PATIENTS WITH HIGH SURGICAL RISK

Surgical mortality and risk It is especially common in young patients, in high cervical locations, anterior cervical locations and neurofibromatosis.

SPINAL CORD MENINGIOMAS ARE MANY TUMORS

Multiple spinal cord meningiomas - Multiple spinal meningioma – very rare, seen in 2% and associated with neurofibromatosis Type 2.

SURGICAL TREATMENT OF SPINAL CORD MENINGIoma

Meningiomas since they are mostly benign lesions, the recurrence rate in total resection has been reported to be low in all series. However, what is important is to determine the tumor location very well, determine the entry point accordingly, and protect the spinal cord. Surgical method: Stripping the arachnoid, Stripping the tumor from surrounding formations, Burning the feeding vessels of the tumor in close-up, Reducing the tumor volume, Dissection from the spinal cord, Observing the adhesion to the dura and cutting off the relationship, and Burning the remains.

PATHOLOGY OF SPINAL CORD MENINGIOMAS

The majority of spinal meningiomas are histologically either meningothelial or It is >psammomatous  type. In a study, while the frequency of meningothelial meningioma was lower in spinal meningioma patients under the age of 50, this rate was found to be higher in elderly cases. While the extension of the tumor outside the spinal cord varies between 4.5-13% in Meningiomas, this type of tumor extension is more common in young cases and shows aggressive behavior.

 Spinal Meningiomas: Pathological Classification WHO:

• Benign (Grade I) - (90%) 

  • Meningothelial,

  • Fibrous, transitional, psammomatous, angioblastic (most aggressive) 

• Atypical (Grade II) - (7%)

  • choroid, clear cell

• Anaplastic/malignant ( Grade III) - (2%)

  • papillary, rhabdoid, anaplastic 

 

TUMOR BIOLOGY OF SPINAL CORD MENINGIOMAS - BEHAVIOR

Divided into 3 grades according to Recurrence and Aggressiveness.

Grade I: Low-risk recurrence and/or slow growth. Most meningiomas are of this grade.

Grade II: High-risk recurrence and/or aggressive growth. Atypical meningioma

Grade III: Very high risk of recurrence and/or aggressive growth. Malignant meningiomas

 

CALCIFIED SPINAL CORD TUMORS MENINGIomaS

The possibility of incomplete removal in the surgical treatment of calcified - calcified meningiomas Due to tumor recurrence - recurrence is common. This condition is common in psammomatous meningioma.

ENPLAQUE MENINGIoma

The “En-Plaque” type of meningioma in the spinal cord is rare.

RECURRENCE OF SPINAL CORD MENINGIOMAS

Recurrence - re-growth of the tumor is common in cases where subtotal resection of the tumor was performed. In addition, recurrence is higher in young patients (<21 years), calcification / Psammomatous meningioma type, extradural location, multiple meningiomas, most plaque and anteriorly located meningiomas.

 

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