Ependymoma is a tumor that arises from the ependyma, a tissue of the central nervous system. Usually, in children the location is intracranial, while in adults it is spinal. The common location of intracranial ependymoma is the fourth ventricle. Rarely, ependymoma can occur in the pelvic cavity.

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Introduction:

Spinal cord tumors are rare but can leave patients neurologically and functionally impaired. Recently, improved testing, such as MRI and CTS,  has allowed these lesions to be diagnosed earlier and intervention can proceed sooner. Microsurgical techniques and other specialized treatments can help to minimize these potentially devastating types of tumors. Types of Tumors:

Spinal tumors can be divided into extradural, intradural extramedullary, and intradural intramedullary.

• Extradural- Those tumors outside the dural covering of the spinal cord.
• Intradural extramedullary – Those tumors inside the dural covering but not within the spinal cord itself.
• Intradural intramedullary – Those tumors inside the dural covering and within the spinal cord itself.

The cell types of these tumors are the same are those of the brain (See list of tumor types).  And many tumors from other parts of the body can metastasize or travel to the spinal cord and cause compression. Listed below are the common occurrence rates of the following tumors that can occur within the spinal cord.

• Ependymoma (56%) The most common intrinsic spinal cord tumor
• Astrocytoma (29%) These lesions are more common in children than in adults.
• Oligodendroglioma (3%)
• Developmental tumors (3%)
• Hemangioblastoma (3%)
• Lipoma (2%)
• Others (4%)

Occurrence:

• Spinal tumors approximately 1.1 case per 100,000 persons.

• Approximately 15-20% of all central nervous system (CNS) tumors occur in the spine.
•  They occur in both the pediatric and adult population.
• They are found most frequently in the thoracic cord but can also occur in the cervical spine to the tail of the spine.
• A tumor can arise from any component of the spinal cord.
• 90% are benign and therefore a surgical “cure” is possible.
• Many are slow growing and take years to cause problems.
• These tumors are occasionally missed in their early stages because of their tendency to mimic other conditions.  (i.e.. back pain from strains or other traumatic injuries)

Symptoms and Signs:

 

• Pain is the usual presentation and this is classically thought to be worse when the patient is supine or flat.  Pain usually radiates to the part of the body (arm or leg) because theses nerves in the cord are being pressed on by the tumor mass. Eventually weakness and abnormal sensations will follow and the tumor advances and finally the bladder and bowel will begin to lose normal function. During this time walking will become difficult and paralysis may then rapidly occur.

   

  Tests:

  Some or all of the following tests maybe needed to determine the extent and location of the tumor.  It is also important to determine if there are other locations of tumor both within the spine or from other organs or tissues.

  • Plain Spinal X-rays
  • CTS with and without contrast dye
  • MRI with and without
  • contrast dye
  • MRA or MRI- angiogram
  • Myelogram
  • Electrical conduction tests – usually used during surgery
  • Angiogram
  • Lumbar puncture