What Is an Intramedullary Spinal Cord Tumor?
Spine tumors are grouped by location into three types: outside the cord's covering, inside the covering but outside the cord, and within the substance of the cord itself (intramedullary). This last group is the least common. Because they are intertwined with critical nerve structures of the cord, the surgery of these tumors is among the most technically demanding spinal operations. In adults the most frequent types are ependymoma and astrocytoma, each behaving differently.
Symptoms — Often Begin Slowly
The first complaint is usually local pain at the tumor level, which may worsen at night. Over time, weakness, loss of fine hand skills and difficulty walking may be added. Some tumors cause a selective loss of pain-temperature sensation and balance disturbance (ataxia). Advanced cases may show changes in bladder and bowel function. Because the symptoms are insidious, diagnosis can take weeks, months or even years; for this reason, persistent, unexplained neurological symptoms should be taken seriously.
Contrast MRI in Diagnosis
The basis of assessment is contrast-enhanced magnetic resonance imaging (MRI). MRI shows the level of the tumor, its extent within the cord, any cystic portions, accompanying fluid collection within the cord (syringomyelia) and the pattern of contrast uptake. These findings help predict the tumor type; however, a definitive diagnosis is made only by pathological examination of tissue taken at surgery. In some situations, screening of the whole nervous system and genetic assessment may be needed.
The Cornerstone of Treatment: Microsurgery
The cornerstone of treatment is microsurgery that aims for the safest possible wide removal while prioritizing preservation of neurological function. Surgery is performed with the operating microscope, an ultrasonic aspirator and intraoperative nerve monitoring (neurophysiological monitoring). In well-circumscribed tumors complete removal is often possible, while in ill-defined (infiltrative) tumors the aim is safe debulking and diagnosis. Depending on tumor type and grade, additional treatments (radiotherapy, etc.) may come up in some cases; some small, asymptomatic lesions can be followed.
After Surgery and Honest Expectations
In the early postoperative period the neurological state is closely monitored; because temporary sensory change or weakness can occur, early rehabilitation is important. The outcome depends on the tumor type, grade and especially the preoperative neurological state — which is why early diagnosis is valuable. Regular MRI follow-up is carried out for recurrence and growth. No outcome is guaranteed; expectations and possible risks are discussed openly from the start.