Section 3 Spinal Tumors

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**Chapter 3**

**Abstract**

**1. Introduction**

Tumors

*Saleh Rasras and Arash Kiani*

Intradural Extramedullary Spinal

Intradural extramedullary (IDEM) spinal tumors are common pathologies, and despite their name, they can extend beyond dural confinements. IDEMs can have both sporadic and syndromic patterns, and various genetic abnormalities are believed to be responsible for these mainly benign pathologies. Meningiomas, nerve sheath tumors (NST), and ependymomas are the three most common subtypes, and due to their pathologically benign nature, surgical total resection plays the most important role in their management. These tumors have always been challenging entities to neurosurgeons, and many surgical techniques have been described in order to achieve gross total resection, and these techniques have continued to evolve over time. Adjuvant therapies such as radiotherapy or radiosurgery are usually considered when total resection is not possible or sometimes in syndromic patients

in order to avoid multiple surgical procedures in a short period of time.

A wide variety of tumors can affect spinal column and cord causing functional or neurological impairment. Axial skeleton tumors can be either primary or secondary with metastatic lesions being the most common and are classified as secondary malignant tumors. On the other hand, primary tumors of the axial skeletons are the ones arising from vertebral bony structures and can also be benign or malignant. The skeletal system is one the most common sites for metastasis with spinal part being the most frequent site [1] due to its cancellous structure and extensive arterial and venous supplies [2]. Cancers with tendency to affect the spinal column are in descending order: prostate, breast, kidney, lung, and thyroid [3] (**Figure 1**). Benign tumors of the spinal column can be diagnosed in both children and adults; in children they could be similar to the tumors of other skeletal areas like giant cell tumors (GCT) or osteoblastomas. Regarding the autopsy studies, vertebral hemangiomas are the most common benign primary lesions of the spinal column in adults and could be seen in up to 20% of the population. Other common benign primary tumors are aneurysmal bone cyst, osteoblastoma, osteoid osteoma,

Malignant primary spinal column tumors tend to occur in older patients than primary ones, and the most commonly occurring tumors are multiple myeloma and plasmacytoma, chordoma, and osteosarcoma in order of frequency (**Figure 1**).

**Keywords:** intradural extramedullary (IDEM), spinal cord, tumor,

nerve sheath tumors (NST), meningioma, ependymoma

GCT, osteochondroma, and enchondroma (**Figure 1**) [4].

## **Chapter 3**
