Intramedullary Spinal Cord Tumors

Intramedullary spinal cord tumors are comprised predominantly of intrinsic gliomas such as astrocytomas and ependymomas. In the majority of cases, they are benign (WHO grade 1 or 2) and the primary treatment option is microsurgical resection. Surgery is usually curative with ependymomas, hemangioblastomas, subependymomas, lipomas, dermoid, and epidermoid tumors due to good cleavage plane from the spinal cord, and when removal is complete, no further therapy is required. Astrocytomas demonstrate infiltrative behavior, and therefore residual and recurrent tumors are frequent. Radiotherapy is indicated for primary malignant tumors (WHO grade 3 and higher), radiosensitive tumors such as lymphoma, germinoma, and for patients in whom surgery is contraindicated. For grade 1–2 tumors, the role of radiotherapy is controversial. Chemotherapy is reserved for recurrent intramedullary spinal cord tumors without other options.