There are many types of tumors which involve the substance of the spinal cord. The pathology can vary from benign (non-cancerous) to highly malignant (cancerous).
The most common tumors intrinsic to the spinal cord include:
- Ependymomas (in or near the membrane lining the spinal canal)
- Astrocytomas (a nerve tissue tumor intermingled with tissue supporting the spine)
The Spine Center at Johns Hopkins develops a personalized treatment plan to address each individual’s unique tumor.
When forming the treatment plan, the Spine Center strives to preserve neurological function, quality of life and ultimately, long-term survival.
With these goals in mind, developing a treatment plan starts with collecting history from the patient. We then perform imaging studies of the spinal cord. High resolution magnetic resonance imaging (MRI) scans with and without contrast administration allows the physician to see the tumor with excellent definition. In some cases, computer tomography (CT) scanning and angiography will be used to collect additional information. After studying the images, a plan for surgery can be made. In some instances, watchful follow-up without surgery may be the ideal course of action.
If surgery is deemed necessary, the pathology of the tumor, the location and characteristics of the tumor and the neurological condition of the patient will dictate the treatment strategy. A surgical biopsy may be necessary prior to the ultimate treatment in order to classify the tumor.
Excellent pathology is the cornerstone to diagnosis and treatment. The Spine Center team will often request a surgical biopsy to be performed prior to planning their surgical approach. This usually involves collecting a frozen section as an initial step. If this section is not sufficient to determine the pathology of the tumor, a patient may need a second biopsy for a more thorough analysis.
After the pathology is known, a definitive surgical procedure can be planned. These tend to be challenging and high-risk neurosurgical procedures. Surgical approaches can include:
- Total resection (removal of the entire tumor) is the goal for low grade tumors with well circumscribed borders. Examples include ependymomas, subependymomas, hemangioblastomas, and paragangliomas
- Cytoreduction of the tumor is the goal for infiltrative tumors (astrocytomas)
The Spine Team at Johns Hopkins uses the most advanced microsurgical techniques, such as:
- Intraoperative monitoring to help understand and minimize risk to the patient including motor evoked potentials, somatosensory evoked potentials and electromyography
- Dorsal column mapping to better understand the anatomy and minimize injury to the sensory pathways during surgery
Because of the location of these tumors, many patients will experience some neurological deficits after surgery. Some patients will only experience minor sensory changes. Others may have more pronounced motor weakness. All patients are evaluated by physical therapy, occupational therapy and physical medicine and rehabilitation based on their individual needs. Inpatient or outpatient rehabilitation will be included in the ultimate treatment plan.
If the removed tumor was malignant, or its location made it impossible to remove the entire tumor, additional therapy will be required. This can include radiotherapy and chemotherapeutic options. The radiotherapeutic options range from whole beam radiation, IMRT, Linac and stereotactic radiosurgery. Our neuro-oncology team helps to construct any necessary chemotherapeutic regimens.
Our team believes the relationship between the neurosurgeon and the patient is a life-long commitment. Our patients receive close follow up and serial imaging to evaluate the control of the tumor. A certain number of patients who have had a spinal cord tumor removed will develop some degree of spinal deformity over time (even if cured of the tumor), and may need further surgical stabilization. We strive to continue the relationship with our patients through the life of their treatment needs.