Prof. Dr. Erkan Kaptanoğlu


Spinal Cord Tumors

Spinal cord tumors are divided into two groups as tumors that develop from the spinal cord itself and tumors that develop from the spinal cord membrane and nerves. They can cause different types of paralysis, loss of sense, urinary, and fecal problems, both by exerting pressure on the spinal cord and by destroying the spinal cord. It is less common in both adults and children compared to brain tumors. The most common tumors of the spinal cord are astrocytoma and ependymoma, while meningioma is the most common tumor in the spinal cord sheath, and schwannoma is the most common tumor in the spinal cord which originates from the nerves in the spinal cord. Spinal cord tumors may cause cyst formation in the spinal cord above and/or below the site of the tumor.


Spinal cord tumors show signs according to location and spinal cord compression. There may be neck, back, and lower back pain. There may be loss of strength and/or sensory loss in the arms and legs due to spinal cord compression. Urinary and fecal incontinence and balance disorders can be observed. The patient’s complaints, history of the disease and examination is very important when making a diagnosis.

  1. Magnetic resonance imaging (MRI) shows the spinal cord and the spinal canal in great detail. If present in the spinal cord, they may indicate tumoral formations, and whether they retain contrast material. MR spectroscopy can be used to determine whether the tumor is malignant or benign in case of tumors that are large enough. In MR tractography, the course of the descending and ascending pathways/fibers in the spinal cord and its relationship with the tumor may be examined.
  2. In some cases, vascular diseases of the spinal cord and glomeruli that cause tumors can be evaluated with angiography.
  3. Electrophysiological tests can be used to evaluate the transmission with nerves. Nerve roots from the spinal cord are evaluated with EMG (Electromyography). MEP (Motor Evoked Potentials) evaluates the motor-motion function of the spinal cord, and SEP (Sensory Evoked Potentials) evaluates the extent of the influence on the spinal cord’s sensory function.

Surgery is the first choice in the treatment of tumors that develop both from the spinal cord itself and from the spinal cord membrane and nerves. Surgery is the first choice in the treatment of benign tumors. A full cure is ensured by removing the tumor. The tumor is also removed first in malignant tumors. Radiotherapy and stereotactic radiosurgery are often used in cases where not all tumors can be removed, in recurrent cases or for tumors with malignant characteristics. Chemotherapy can be used as adjunct to radiotherapy. The main goal here is to remove the tumor without allowing it to overgrow and cause serious neurological deficits in the patient. In order to protect the spinal cord during surgery and to prevent the paralysis of the patient, advanced surgical microscopes and intraoperative neuromonitoring are almost always used.

For neuromonitoring, the patient is anesthetized with special anesthesia techniques. Electrodes are attached to the head and extremities (arms and legs). EMG, MEP, SEP monitoring is performed continuously and in real time throughout the operation. It alerts the surgeon in case of any danger. Although it does not always yield 100% accurate results, it may help during surgery even in case of a margin of error.


MRI is performed on the 3rd, 6th and 12th months after surgery. Close follow-up is necessary for malignant tumors as there is a risk of recurrence.


They are usually benign tumors. They can rarely be malignant. They can cause different types of paralysis by pressing on the spinal cord and destroying the spinal cord tissue. Complete recovery is expected when it is removed entirely by surgery.


These tumors can be both benign and malignant. These tumors, like astrocytomas, can cause different types of paralysis by compressing and destroying the spinal cord tissue. Benign ones can be cured when totally removed. In malignant ones, additional treatments such as radiotherapy may be required. Those that are located at the bottom of the spinal cord are often benign (filum terminale ependymomas). These tumors can develop after the spread of the same type of tumor that is located in the brain via the cerebrospinal fluid.


These tumors are tumors that develop from the cerebrospinal membranes. They are benign in most cases and rarely malignant. In some cases, they may be calcified and can be very hard. These tumors usually show signs after compressing the spinal cord and resulting in the development of paralysis. Complete recovery is expected when it is entirely removed.


These tumors develop from the sheath of the nerves coming out of the spinal cord and may extend along the course of the nerve. They may be located between the dura membrane and the spinal cord and/or outside the dura, as well as in forms that are located in both areas and holding the vertebrae. They are usually benign, but in some cases they can be malignant. While the benign ones are expected to fully recover when they are completely removed, it may not always be possible to remove them totally. In some cases they can reach very large sizes if the symptoms only appear in late stages. Since these tumors are adjacent to the nerves, it may be necessary to cut the nerves during surgery, which may lead to paralyses such as loss of sense and strength. Malignant ones may require additional treatment such as radiotherapy and chemotherapy in addition to surgery.

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