Which are the most common spinal cord tumors?
Spinal ependymomas represent 60% of intramedullary spinal neoplasms in adults, and 30% in the paediatric group, therefore, they constitute the most common tumour of the medulla overall.
Where do spinal ependymomas arise?
Spinal ependymomas originate from differentiated cells lining the surface of the central medullar canal or cell rests along the filum.
What are the most common clinical signs and symptoms of ependymomas?
The most common clinical manifestations of patients with ependymomas are pain and sensory symptoms, similar to other intramedullary spinal tumors.
What are the radiological features of ependymomas?
On CT or MRI, ependymomas are well-circumscribed enhancing masses that occupy the central portion of the spinal cord and cause symmetric expansion. On CT, these tumours are iso to slightly hyper-attenuating compared with the spinal cord; On MRI, ependymomas are usually iso to hypointense on T1 and hyperintense on T2. Spinal ependymomas may be heterogeneous masses reflecting the areas of haemorrhage, necrosis, and cystic degeneration. Calcification is uncommon. Associated hemorrhage usually occurs at the superior and inferior margins of the tumor, and may lead to a hypointense hemosiderin rim on T2 WI, which is called the “cap sign.” These lesions show intense homogeneous and occasionally inhomogeneously enhancement, either on CT or MRI. Syringohydromyelia and medullary edema adjacent to the tumor may occur. There may be scoliosis, spinal canal widening, vertebral body scalloping, and neural exit foramina enlargement.
What are the treatment choices for spinal ependymomas?
Usually, the treatment of choice is maximal safe surgical resection, which may be associated with local radiation therapy. Some studies recommend chemotherapy for a recurrence of the tumor.
A well-demarcated central intramedullary tumour at T11-T12, which is isointense on T1, heterogeneously hyperintense on T2 and has intense contrast enhancement. There is a small polar cyst component at the inferior margin of the tumour. This mass promotes local cord expansion. The lesion measures 1.2 x 1,2 x 2,8 cm. There is a hyperintense T2 signal in the medulla segment above the tumor, which may represent edema and some syringomyelia component.