Intradural, Intramedullary Tumor

  • Mari L. GrovesEmail author
  • George Jallo


Intramedullary spinal cord tumors (IMSCTs) are rare lesions and represent 2–4% of all central nervous system neoplasms. Primary glial tumors, ependymomas, and astrocytomas, as well as hemangioblastomas, represent well over 90% of IMSCTs. For these low-grade lesions, an attempt at gross total resection has been shown to impact progression-free survival as well as overall survival. Intraoperative neuromonitoring has emerged as an important adjunct for surgical resection and can help guide the extent of resection by providing real-time feedback that impacts the extent of resection. Gross total resection can be safely achieved in cases where there is an identifiable plane between the tumor and normal spinal cord. Higher grade lesions often do not have clear planes, and there is limited utility in aggressive surgical resection. Functional outcomes are determined by the patient’s preoperative status as most patients will maintain their preoperative function, with only a few showing some improvement. Technological advances have pushed surgical techniques for IMSCT resection and have improved our ability to more aggressively treat these lesions.


Intramedullary Spinal cord tumors Ependymoma Astrocytoma Intraoperative neuromonitoring Laminoplasty Surgical technique 


  1. 1.
    Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ. Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg. 2000;93(2 Suppl):183–93.PubMedGoogle Scholar
  2. 2.
    Sciubba DM, Liang D, Kothbauer KF, Noggle JC, Jallo GI. The evolution of intramedullary spinal cord tumor surgery. Neurosurgery. 2009;65(6 Suppl):84–91. discussion 91-2.PubMedGoogle Scholar
  3. 3.
    Boström A, von Lehe M, Hartmann W, Pietsch T, Feuss M, Boström JP, Schramm J, Simon M. Surgery for spinal cord ependymomas: outcome and prognostic factors. Neurosurgery. 2011;68(2):302–8.CrossRefGoogle Scholar
  4. 4.
    Parsa AT, Lee J, Parney IF, Weinstein P, McCormick PC, Ames C. Spinal cord and intradural-extraparenchymal spinal tumors: current best care practices and strategies. J Neuro-Oncol. 2004;69(1–3):291–318.CrossRefGoogle Scholar
  5. 5.
    Yang I, Parsa AT. Intramedullary spinal cord tumors. In: Gupta N, Banerjee A, Haas-Kogan D, editors. Pediatric CNS tumors. Berlin, Heidelberg: Springer; 2010. p. 187–204.Google Scholar
  6. 6.
    Lee M, Rezai AR, Freed D, Epstein FJ. Intramedullary spinal cord tumors in neurofibromatosis. Neurosurgery. 1996;38(1):32–7.CrossRefGoogle Scholar
  7. 7.
    Kucia EJ, Bambakidis NC, Chang SW, Spetzler RF. Surgical technique and outcomes in the treatment of spinal cord ependymomas, part 1: intramedullary ependymomas. Neurosurgery. 2011;68(1 Suppl operative):57–63.PubMedGoogle Scholar
  8. 8.
    Ardeshiri A, Chen B, Hütter BO, Oezkan N, Wanke I, Sure U, Sandalcioglu IE. Intramedullary spinal cord astrocytomas: the influence of localization and tumor extension on resectability and functional outcome. Acta Neurochir. 2013;155(7):1203–7.CrossRefGoogle Scholar
  9. 9.
    Liu A, Sankey EW, Bettegowda C, Burger PC, Jallo GI, Groves ML. Poor prognosis despite aggressive treatment in adults with intramedullary spinal cord glioblastoma. J Clin Neurosci. 2015;22(10):1628–31. Epub 2015 Jun 30.CrossRefPubMedGoogle Scholar
  10. 10.
    Waxman SG. Correlative neuroanatomy. 23rd ed. Stamford: Appleton & Lange; 1996. p. 45–68.Google Scholar
  11. 11.
    Hanbali F, Fourney DR, Marmor E, et al. Spinal cord ependymoma: radical surgical resection and outcome. Neurosurgery. 2002;51(5):1162–72.CrossRefGoogle Scholar
  12. 12.
    Vaccaro AR, Albert TJ. Spine surgery: tricks of the trade. 2nd ed. New York: Thieme; 2008.Google Scholar
  13. 13.
    de Jonge T, Slullitel H, Dubousset J, Miladi L, Wicart P, Illes T. Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours. Eur Spine J. 2005;14:765–71.CrossRefGoogle Scholar
  14. 14.
    Papagelopoulos PJ, Peterson HA, Ebersold MJ, Emmanuel PR, Choudhury SN, Quast LM. Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine (Phila Pa 1976). 1997;22:442–51.CrossRefGoogle Scholar
  15. 15.
    Hersh DS, Iyer RR, Garzon-Muvdi T, Liu A, Jallo GI, Groves ML. Instrumented fusion for spinal deformity after laminectomy or laminoplasty for resection of intramedullary spinal cord tumors in pediatric patients. Neurosurg Focus. 2017;43(4):E12. Scholar
  16. 16.
    Parker SL, Kretzer RM, Recinos PF, Molina CA, Wolinsky JP, Jallo GI, Recinos VR. Ultrasonic BoneScalpel for osteoplastic laminoplasty in the resection of intradural spinal pathology: case series and technical note. Neurosurgery. 2013;73(1 Suppl Operative):ons61–6. Scholar
  17. 17.
    Takami T, Yamagata T, Naito K, Arima H, Ohata K. Intraoperative assessment of spinal vascular ow in the surgery of spinal intramedullary tumors using indocyanine green videoangiography. Surg Neurol Int. 2013;4:135.CrossRefGoogle Scholar
  18. 18.
    Mende KC, Krätzig T, Mohme M, Westphal M, Eicker SO. Keyhole approaches to intradural pathologies. Neurosurg Focus. 2017;43(2):E5.CrossRefGoogle Scholar
  19. 19.
    Jallo GI, Kothbauer KF, Epstein FJ. Intrinsic spinal cord tumor resection. Neurosurgery. 2001;49(5):1124–8.PubMedGoogle Scholar
  20. 20.
    Woodworth GF, Chaichana KL, McGirt MJ, Sciubba DM, Jallo GI, Gokaslan Z, et al. Predictors of ambulatory function after surgical resection of intramedullary spinal cord tumors. Neurosurgery. 2007;61(1):99–105.CrossRefGoogle Scholar
  21. 21.
    Sala F, Palandri G, Basso E, Lanteri P, Deletis V, Faccioli F, et al. Motor evoked potential moni- toring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery. 2006;58:1129–43. [discussion: 1129-1143].CrossRefGoogle Scholar
  22. 22.
    Jin SH, Chung CK, Kim CH, Choi YD, Kwak G, Kim BE. Multimodal intraoperative monitoring during intramedullary spinal cord tumor surgery. Acta Neurochir. 2015;157:2149–55.CrossRefGoogle Scholar
  23. 23.
    Muramoto A, Imagama S, Ito Z, Ando K, Tauchi R, Matsumoto T, et al. The cutoff amplitude of transcranial motor evoked potentials for transient postoperative motor deficits in intra- medullary spinal cord tumor surgery. Spine. 2014;39:E1086–94.CrossRefGoogle Scholar
  24. 24.
    Kothbauer KF, Deletis V, Epstein FJ. Motor- evoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in a series of 100 consecutive procedures. Neurosurg Focus. 1998;4:e1.PubMedGoogle Scholar
  25. 25.
    Eroes CA, Zausinger S, Kreth FW, Goldbrunner R, Tonn JC. Intramedullary low grade astrocytoma and ependymoma. Surgical results and predicting factors for clinical outcome. Acta Neurochir. 2010;152:611–8.CrossRefGoogle Scholar
  26. 26.
    Garcés-Ambrossi GL, McGirt MJ, Mehta VA, Sciubba DM, Witham TF, Bydon A, et al. Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases. Clinical article. J Neurosurg Spine. 2009;11:591–9.CrossRefGoogle Scholar
  27. 27.
    Cristante L, Herrmann HD. Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery. 1994;35(1):69–74. discussion 74-6.CrossRefGoogle Scholar
  28. 28.
    Albert TJ, Vacarro A. Postlaminectomy kyphosis. Spine (Phila Pa 1976). 1998;23:2738–45.CrossRefGoogle Scholar
  29. 29.
    McGirt MJ, Chaichana KL, Atiba A, Bydon A, Witham TF, Yao KC, Jallo GI. Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty. J Neurosurg Pediatr. 2008;1:57–62.CrossRefGoogle Scholar
  30. 30.
    Klekamp J. Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results. J Neurosurg Spine. 2013;19(1):12–26. Scholar
  31. 31.
    Fischer G, Brotchi J. Intramedullary spinal cord tumors. Stuttgart: Thieme; 1996.Google Scholar
  32. 32.
    McGirt MJ, Chaichana KL, Atiba A, Attenello F, Yao KC, Jallo GI. Resection of intramedullary spinal cord tumors in children: assessment of long-term motor and sensory de cits. J Neurosurg Pediatr. 2008;1:63–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Johns Hopkins HospitalDepartment of NeurosurgeryBaltimoreUSA
  2. 2.Johns Hopkins All Children’s HospitalDepartment of NeurosurgerySt. PetersburgUSA

Personalised recommendations