Экстра и интрамедуллярные опухоли спинного мозга
Clinically, spinal cord tumors are divided into three main groups based on their location relative to the dura mater: intradural extramedullary, intramedullary, and extradural.
Intradural extramedullary tumors develop from the meninges of the spinal cord (meningiomas), in the nerve roots that emerge from the spinal cord (schwannomas and neurofibromas), or from the spinal cord (ependymomas of the terminal thread). Although meningiomas are often benign, they can be difficult to remove and are prone to recurrence. Nerve root tumors are also usually benign, although neurofibromas may become malignant over time. Ependymoma of the terminal thread of the spinal cord can reach enormous sizes, and treatment is complicated by the complex nature of the relationships of neural structures in this area.
Intramedullary tumors grow within the spinal cord or individual nerves, and are most common in the cervical region. They usually develop from glial or ependymal cells. Astrocytoma and ependymoma are the two most common types. They are usually benign but can be difficult to remove. Intramedullary lipomas are rare congenital tumors that are most often located in the thoracic spinal cord.
Extradural lesions are usually due to metastatic cancer or schwannomas that originate from the sheath cells of the nerve roots. Sometimes extradural tumors extend through the intervertebral foramina and are partly inside and partly outside the spinal canal (an "hourglass" appearance).
Symptoms
Back pain, especially in the middle or lower back, is the most common symptom of both benign and malignant spinal cord tumors. This back pain is not associated with trauma, stress, or physical activity. However, the pain may be aggravated by movement and may be worse at night. The pain may extend beyond the back to the thigh, shin, foot or arms and may increase over time, even with treatment with conservative, non-surgical methods that are usually used for back pain caused by non-neoplastic diseases (radiculitis, lumbago, etc.).
Depending on the location and type of tumor, other symptoms of damage may appear, especially if the malignant tumor grows and presses on the spinal cord, nerve roots, grows into blood vessels or bones of the spine. Compression of the spinal cord by a tumor is an extremely dangerous complication. The following symptoms may be present:
- Impaired sensitivity in the legs, arms or chest.
- Difficulty moving, clumsiness.
- Decreased sensitivity to pain, heat and cold.
- Impaired bowel and bladder function.
- Paralysis of various areas of the body, the level of which is expressed depending on the degree of damage to the spinal cord or nerves.
- Scoliosis or other spinal deformities resulting from the development of a large but benign tumor.