Medical and health

1. SPINAL CORD TUMOURS
KENESHBEK YRYSOV MD., PhD.
KYRGYZ STATE MEDICAL ACADEMY
Dpt. NEUROSURGERY

3. SPINAL CORD TUMOURS
Incidence
- Extradural 78% in adults (Metastasis,
myeloma, neurofibroma, lymphoma)
- Intradural 18% (Meningioma, schwannoma)
- Intramedullary 4% (Astrocytoma, others)

4. SPINAL CORD TUMOURS
Clinical features
These depend on the site and level of the
compressive lesion
Pain
- Root: severe, sharp, shooting, burning pain, radiating
into the cutaneous distribution or muscle group
supplied by the root; aggravated by movement,
straining or caughing

5. SPINAL CORD TUMOURS
Segmental: continuous, deep, aching pain,
radiating into whole leg or one half body; not
affected by movement
Bone: continuous, dull pain and tenderness
over the affected area; may or may not be
aggravated by movement

6. SPINAL CORD TUMOURS
Muscle weakness
Signs: wasting – loss of tone – fascicultaion –
diminished or absent reflexes
Sensory defect
anesthesia, hypoesthesia …

7. SPINAL CORD TUMOURS
Brown-Sequard syndrome
- Ipsilateral pyramidal weakness + impaired
joint position sense and accurate touch
localistaion
- Contralateral impairment of pain and
temperature sensation
- Ipsilateral root/segmental signs

8. SPINAL CORD TUMOURS
Bladder disfunction
Patient first notices difficulty in initiating
micturition. Retention follows, associated with
incontinence as automatic emptying occurs.
Constipation is only noticed after a few days.
Some patients develop priapism (painful
erection).

9. SPINAL CORD TUMOURS
Vertebral column
- Scoliosis, loss of lordosis or limitation of
straight leg raising
- Paravertebral swelling
- Tenderness of bone percussion
- Restricted spinal mobility
- Sacral dimple or tuft of hair

10. SPINAL CORD TUMOURS
Investigation
X-Ray (straight, lateral, oblique views)
MRI – investigation of choice for spinal disease
Myelography (if MRI unavailable)
Identify the level of compressive lesion; partial block,
complete block.

11. X-ray of spine

12. MRI

13. MRI

14. MRI

15. SPINAL CORD TUMOURS
Investigation
CT scan/CT myelography
CSF analysis
- Protein often increased, especially below a
complete block;
- Cell count;
- Cytology may reveal tumour cells;

16. Lumbar Puncture

17. SPINAL CORD TUMOURS
Management
Surgical
Aims:
- To establish a diagnosis if not already known
- To decompress the spinal cord yet maintain
stability of vertebral column
- To produce stability if instability causes
excessive pain

18. Surgical management

19. Surgical management

20. Surgical management

21. IntraOP view

22. SPINAL CORD TUMOURS
Management
Radiotherapy (initial treatment, once the
diagnosis is established)
Prognosis
Outcome depends on the nature of the
primary tumour.

23. Gamma knife

24. Literature

25. Danke ! Рахмат !
Спасибо ! Thank You !