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Neurological Aspects of Spinal Cord Tumors

  • Tania Hassanzadeh
  • Sushma Bellamkonda
  • Sajid S. Suriya
  • Farzad H. Adl
  • Andrei V. Alexandrov
  • Martin M. Mortazavi
Chapter

Abstract

This chapter discusses neurological aspects of spinal cord tumors, including clinical symptoms and syndromes, examination techniques, and diagnostic modalities. An emphasis is placed on earlier disease diagnosis as spinal cord tumors are known for delayed diagnoses. Usual causes for this delay consist of slow progression, an incomplete physical examination or misinterpretation of exam findings, late pursuit of imaging, imaging at the incorrect level, or nonspecific symptoms—such as back pain—that is misconstrued as the more prevalent degenerative spine disease. Every physician should maintain an elevated level of suspicion of spinal cord tumors and take the appropriate steps toward diagnosis, until neoplastic disease is definitively ruled out.

Keywords

Spinal cord tumors Intramedullary tumors Intradural-extramedullary tumors Extradural-extramedullary tumors 

Notes

Acknowledgements

The authors would like to thank Dr. Xin S. Xin, DO and Dr. Ha Son Nguyen, MD for their contribution to this work.

References

  1. 1.
    Segal D, Lidar Z, Corn A, Constantini S. Delay in diagnosis of primary intradural spinal cord tumors. Surg Neurol Int. 2012;3:52.  https://doi.org/10.4103/2152-7806.96075.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kato M, Nakamura H, Terai H, Konishi S, Nagayama R, Takaoka K. Why does delay exist in the diagnosis of intradural spinal cord tumor despite the availability of MRI? J Clin Neurosci. 2008;15(8):880–5.  https://doi.org/10.1016/j.jocn.2007.03.019.CrossRefPubMedGoogle Scholar
  3. 3.
    Borm W, Gleixner M, Klasen J. Spinal tumors in coexisting degenerative spine disease--a differential diagnostic problem. Eur Spine J. 2004;13(7):633–8.  https://doi.org/10.1007/s00586-004-0678-4.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Epstein FJ, Farmer JP, Freed D. Adult intramedullary spinal cord ependymomas: the result of surgery in 38 patients. J Neurosurg. 1993;79(2):204–9.  https://doi.org/10.3171/jns.1993.79.2.0204.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Jellema K, Overbeeke JJ, Teepen HL, Visser LH. Time to diagnosis of intraspinal tumors. Eur J Neurol. 2005;12(8):621–4.  https://doi.org/10.1111/j.1468-1331.2005.01043.x.CrossRefPubMedGoogle Scholar
  6. 6.
    Grimm S, Chamberlain MC. Adult primary spinal cord tumors. Expert Rev Neurother. 2009;9(10):1487–95.  https://doi.org/10.1586/ern.09.101.CrossRefGoogle Scholar
  7. 7.
    Hogenesch RI, Staal MJ. Tumors of the cauda equina: the importance of an early diagnosis. Clin Neurol Neurosurg. 1988;90(4):343–8.CrossRefGoogle Scholar
  8. 8.
    Greenberg MS. Handbook of neurosurgery. 8th ed. New York: Thieme; 2016.Google Scholar
  9. 9.
    Parker AP, Robinson RO, Bullock P. Difficulties in diagnosing intrinsic spinal cord tumours. Arch Dis Child. 1996;75(3):204–7.CrossRefGoogle Scholar
  10. 10.
    Welch WC, Jacobs GB. Surgery for metastatic spinal disease. J Neuro-Oncol. 1995;23(2):163–70.CrossRefGoogle Scholar
  11. 11.
    Bilsky MH. New therapeutics in spine metastases. Expert Rev Neurother. 2005;5(6):831–40.  https://doi.org/10.1586/14737175.5.6.831.CrossRefPubMedGoogle Scholar
  12. 12.
    Mechtler LL, Nandigam K. Spinal cord tumors: new views and future directions. Neurol Clin. 2013;31(1):241–68.  https://doi.org/10.1016/j.ncl.2012.09.011.CrossRefPubMedGoogle Scholar
  13. 13.
    Lossos A, Siegal T. Electric shock-like sensations in 42 cancer patients: clinical characteristics and distinct etiologies. J Neuro-Oncol. 1996;29(2):175–81.CrossRefGoogle Scholar
  14. 14.
    Posner JB. Neurologic complications of Cancer. 2nd ed: Oxford University Press; 2008.Google Scholar
  15. 15.
    Ropper AE, Ropper AH. Acute spinal cord compression. N Engl J Med. 2017;376(14):1358–69.  https://doi.org/10.1056/NEJMra1516539.CrossRefPubMedGoogle Scholar
  16. 16.
    Blumenfeld H. Neuroanatomy through clinical cases. 2nd ed. Sunderland, MA: Sinauer Associates; 2010.Google Scholar
  17. 17.
    Kaballo MA, Brennan DD, El Bassiouni M, Skehan SJ, Gupta RK. Intramedullary spinal cord metastasis from colonic carcinoma presenting as Brown-Sequard syndrome: a case report. J Med Case Rep. 2011;5:342.  https://doi.org/10.1186/1752-1947-5-342.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Uchida K, Nakajima H, Takamura T, Kobayashi S, Tsuchida T, Okazawa H, et al. Neurological improvement associated with resolution of irradiation-induced myelopathy: serial magnetic resonance imaging and positron emission tomography findings. J Neuroimaging. 2009;19(3):274–6.  https://doi.org/10.1111/j.1552-6569.2008.00284.x.CrossRefPubMedGoogle Scholar
  19. 19.
    Novy J. Spinal cord syndromes. Front Neurol Neurosci. 2012;30:195–8.  https://doi.org/10.1159/000333682.CrossRefPubMedGoogle Scholar
  20. 20.
    Lin V. Spinal cord medicine: principles and practice. New York: Demos Medical Publishing; 2002.Google Scholar
  21. 21.
    Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007;16(3):307–19.  https://doi.org/10.1007/s00586-006-0225-6.CrossRefPubMedGoogle Scholar
  22. 22.
    Weston CL, Glantz MJ, Connor JR. Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. Fluids Barriers CNS. 2011;8(1):14.  https://doi.org/10.1186/2045-8118-8-14.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Chamberlain MC, Glantz M, Groves MD, Wilson WH. Diagnostic tools for neoplastic meningitis: detecting disease, identifying patient risk, and determining benefit of treatment. Semin Oncol. 2009;36(4 Suppl 2):S35–45.  https://doi.org/10.1053/j.seminoncol.2009.05.005.CrossRefPubMedGoogle Scholar
  24. 24.
    Connolly ID, Li Y, Pan W, Johnson E, You L, Vogel H, et al. A pilot study on the use of cerebrospinal fluid cell-free DNA in intramedullary spinal ependymoma. J Neuro-Oncol. 2017;135(1):29–36.  https://doi.org/10.1007/s11060-017-2557-y.CrossRefGoogle Scholar
  25. 25.
    Wang Y, Springer S, Zhang M, McMahon KW, Kinde I, Dobbyn L, et al. Detection of tumor-derived DNA in cerebrospinal fluid of patients with primary tumors of the brain and spinal cord. Proc Natl Acad Sci U S A. 2015;112(31):9704–9.  https://doi.org/10.1073/pnas.1511694112.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Sevick RJ, Wallace CJ. MR imaging of neoplasms of the lumbar spine. Magn Reson Imaging Clin N Am. 1999;7(3):539–53. ixPubMedGoogle Scholar
  27. 27.
    Evans DG. Neurofibromatosis 2 [bilateral acoustic neurofibromatosis, central neurofibromatosis, NF2, neurofibromatosis type II]. Genet Med. 2009;11(9):599–610.  https://doi.org/10.1097/GIM.0b013e3181ac9a27.CrossRefPubMedGoogle Scholar
  28. 28.
    Dow G, Biggs N, Evans G, Gillespie J, Ramsden R, King A. Spinal tumors in neurofibromatosis type 2. Is emerging knowledge of genotype predictive of natural history? J Neurosurg Spine. 2005;2(5):574–9.  https://doi.org/10.3171/spi.2005.2.5.0574.CrossRefGoogle Scholar
  29. 29.
    Piotrowski A, Xie J, Liu YF, Poplawski AB, Gomes AR, Madanecki P, et al. Germline loss-of-function mutations in LZTR1 predispose to an inherited disorder of multiple schwannomas. Nat Genet. 2014;46(2):182–7.  https://doi.org/10.1038/ng.2855.CrossRefPubMedGoogle Scholar
  30. 30.
    MacCollin M, Willett C, Heinrich B, Jacoby LB, Acierno JS Jr, Perry A, Louis DN. Familial schwannomatosis: exclusion of the NF2 locus as the germline event. Neurology. 2003;60(12):1968–74.CrossRefGoogle Scholar
  31. 31.
    MacCollin M, Chiocca EA, Evans DG, Friedman JM, Horvitz R, Jaramillo D, et al. Diagnostic criteria for schwannomatosis. Neurology. 2005;64(11):1838–45.  https://doi.org/10.1212/01.WNL.0000163982.78900.AD.CrossRefGoogle Scholar
  32. 32.
    Plotkin SR, Blakeley JO, Evans DG, Hanemann CO, Hulsebos TJ, Hunter-Schaedle K, et al. Update from the 2011 international Schwannomatosis workshop: from genetics to diagnostic criteria. Am J Med Genet A. 2013;161A(3):405–16.  https://doi.org/10.1002/ajmg.a.35760.CrossRefPubMedGoogle Scholar
  33. 33.
    Gossage L, Eisen T, Maher ER. VHL, the story of a tumour suppressor gene. Nat Rev Cancer. 2015;15(1):55–64.  https://doi.org/10.1038/nrc3844.CrossRefPubMedGoogle Scholar
  34. 34.
    Zadnik PL, Gokaslan ZL, Burger PC, Bettegowda C. Spinal cord tumours: advances in genetics and their implications for treatment. Nat Rev Neurol. 2013;9(5):257–66.  https://doi.org/10.1038/nrneurol.2013.48.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Chamberlain MC, Tredway TL. Adult primary intradural spinal cord tumors: a review. Curr Neurol Neurosci Rep. 2011;11(3):320–8.  https://doi.org/10.1007/s11910-011-0190-2.CrossRefGoogle Scholar
  36. 36.
    Neumann HP, Eggert HR, Weigel K, Friedburg H, Wiestler OD, Schollmeyer P. Hemangioblastomas of the central nervous system. A 10-year study with special reference to von Hippel-Lindau syndrome. J Neurosurg. 1989;70(1):24–30.  https://doi.org/10.3171/jns.1989.70.1.0024.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Maher ER, Neumann HP, Richard S. von Hippel-Lindau disease: a clinical and scientific review. Eur J Hum Genet. 2011;19(6):617–23.  https://doi.org/10.1038/ejhg.2010.175.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Smith MJ, Bowers NL, Bulman M, Gokhale C, Wallace AJ, King AT, et al. Revisiting neurofibromatosis type 2 diagnostic criteria to exclude LZTR1-related schwannomatosis. Neurology. 2017;88(1):87–92.  https://doi.org/10.1212/WNL.0000000000003418.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Tania Hassanzadeh
    • 1
  • Sushma Bellamkonda
    • 2
  • Sajid S. Suriya
    • 3
  • Farzad H. Adl
    • 4
  • Andrei V. Alexandrov
    • 2
  • Martin M. Mortazavi
    • 4
  1. 1.Department of Otolaryngology—Head and Neck SurgeryTufts Medical CenterBostonUSA
  2. 2.Department of NeurologyUniversity of Tennessee Health Science CenterMemphisUSA
  3. 3.California Institute of NeuroscienceThousand OaksUSA
  4. 4.National Skull Base FoundationThousand OaksUSA

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