Spinal intramedullary tumors

Intramedullary spinal cord tumors constitute an uncommon group of central nervous system neoplasms which pose considerable diagnostic and management challenges. Often low grade, these tumors have an insidious onset and slow progression, which makes early diagnosis a challenge. Advances in magnetic resonance imaging technology have greatly aided the diagnosis and preoperative planning of intramedullary tumors. Yet, radiological diagnosis can be difficult in the presence of several tumor mimics. The introduction and advancement of microsurgical techniques have made surgery the preferred treatment modality. Timing of intervention, however, is contentious. Eloquence of the surrounding tissue and the unforgiving nature of the spinal cord adds to the surgical challenge. Their treatment and prognosis is largely dependent on tumor histology and patient functionality. Well-demarcated tumors like ependymomas and hemangioblastomas can be resected completely with good outcome. Infiltrative tumors such as high-grade astrocytomas are best managed with biopsies or limited resections. Postoperative deficits can be crippling and the use of intraoperative neurophysiologic monitoring and other adjuncts is mandatory. Subtotal resection carry a high risk of recurrence and gross total resection carries a high risk of operative morbidity. With the availability of newer imaging modalities and intraoperative adjuncts, the earlier pessimistic conservative approach has been replaced by an aggressive surgical approach. This review provides an overview on the entire spectra of spinal intramedullary tumors with particular focus on management strategies.