Tumors of a spinal cord
Tumors of a spinal cord — the new growths of primary and metastatic character which are localized in okolospinnomozgovy space, covers or substance of a spinal cord. The clinical picture of spinal tumors is variable and can include a radicular syndrome, segmentary and conduction touch frustration, one - or bilateral paresis is lower than defeat level, pelvic violations. In diagnostics application of a X-ray analysis of a backbone, a contrast miyelografiya, liquorodynamic tests and a research of a likvor is possible, but the leading method is backbone MRT. Treatment is performed only in the surgical way, the chemotherapy and beam influence have auxiliary value. Operation can consist in radical or partial removal of a spinal new growth, depletion of his cyst, carrying out a decompression of a spinal cord.
Tumors of a spinal cord
Most often the tumor of a spinal cord is diagnosed for aged people from 30 to 50 years, occurs at children in rare instances. In structure of tumors of TsNS at adults about 12% fall to the share of new growths of a spinal cord, children have about 5%. Unlike brain tumors, spinal tumors have mainly extra brain arrangement. Only 15% from them originate directly in substance of a spinal cord, other 85% arise in various structures of the vertebral channel (fatty cellulose, covers of a spinal cord, vessels, spinal backs). Vertebrogenny, i.e. growing from vertebras, new growths belong to tumors of bones.
The modern clinical neurosurgery and neurology use several main classifications of spinal new growths in the practice. In relation to a spinal cord of a tumor subdivide on ekstramedullyarny (80%) and intramedullyarny (20%). The tumor of a spinal cord of ekstramedullyarny type develops from the fabrics surrounding a spinal cord. It can have subduralny and epiduralny localization. In the first case the new growth initially is under a firm brain cover, in the second — over it. Subduralny tumors in most cases have good-quality character. 75% from them make nevrinoma and meningioma. Nevrinoma is resulted by metaplaziya of shvannovsky cages of back backs of a spinal cord and clinically debut a radicular pain syndrome. Meningioma originate in a firm brain cover and strong grow together with it. Ekstraduralny tumors have very variable morphology. Neurofibromas, nevrinoma, lymphoma, holesteatoma, lipomas, neuroblastomas, osteosarcomas, hondrosarkoma, myelomas can act as such new growths.
The Intramedullyarny tumor of a spinal cord grows from its substance and therefore demonstrates segmentary frustration. The majority of such tumors is presented by gliomas. It should be noted that spinal gliomas have more good-quality current, than brain gliomas. Among them the ependimoma to which share 20% of all spinal new growths fall meets more often. Usually it settles down in the field of cervical or lumbar thickenings, is more rare — in a horse tail. Are less widespread inclined to cystous transformation of an astrotsitom and the malignant glioblastoma differing in intensive infiltrative growth.
Proceeding from localization the tumor of a spinal cord can be kraniospinalny, cervical, chest, lumbar and sacral and a tumor of a horse tail. About 65% of spinal educations are related to chest department.
On the origin the tumor of a spinal cord can be primary or metastatic. Spinal metastasises can give: gullet cancer, malignant tumors of a stomach, breast cancer, lung cancer, prostate cancer, kidney and cellular cancer, granular and cellular carcinoma of a kidney, cancer of a thyroid gland.
Symptoms of a tumor of a spinal cord
The clinic of spinal new growths distinguishes 3 syndromes: radicular, brounsekarovskiya (diameter of a spinal cord is struck half) and full cross defeat. About a current of time any tumor of a spinal cord, irrespective of its location, leads to defeat of its diameter. However development of symptomatology in process of growth intra-and an ekstramedullyarny tumor considerably differs. Growth of ekstramedullyarny educations is followed by gradual change of stages of a radicular syndrome, brounsekarovsky syndrome and total defeat of diameter. At the same time damage of a spinal cord at the initial stages is caused by development of a compression miyelopatiya, and already then — germination of a tumor. Intramedullyarny tumors begin with emergence on education level of the dissociated touch violations on segmentary type. Then gradually there is a checkmate of spinal diameter. The radicular simptomokompleks arises at late stages when the tumor extends out of limits of a spinal cord.
The radicular syndrome is characterized by the intensive pain of radicular type amplifying at cough, sneezing, a ducking, physical activity, a natuzhivaniye. Usually increase of pain in horizontal position and its easing when sitting. Therefore patients often should sleep semi-sitting. Over time segmentary loss of all types of touch perception and frustration of reflexes in a back innervation zone joins a pain syndrome. At percussion of awned shoots at the level of a spinal tumor there is a pain irradiating in lower body. The disease debut from a radicular syndrome is most typical for an ekstramedullyarny tumor of a spinal cord, especially for a nevrinoma. The similar demonstration of a disease quite often leads to mistakes in primary diagnostics as the radicular syndrome of tumoral genesis clinically not always manages to be differentiated from the radiculitis caused by inflammatory changes of a back at infectious diseases and pathology of a spine column (osteochondrosis, a hernia nuclei pulposi, a spindiloartroza, scoliosis, etc.).
Broun-Sekar's syndrome represents a combination of gomolateralny central paresis below the place of damage of a spinal cord and the dissociated touch frustration on conduction type. The last include loss of deep types — vibration, musculoarticulate — sensitivity on the party of a tumor and decrease in painful and temperature perception on the opposite side. At the same time, except conduction touch violations on the party of defeat, segmentary disorders of superficial perception are noted.
Total defeat of spinal diameter is clinically shown bilateral conduction by losses of both deep, and superficial sensitivity and bilateral paresis lower than the level at which the tumor of a spinal cord is located. The disorder of pelvic functions menacing with development of an urosepsis is noted. Vegetative and trophic violations lead to developing of decubituses.
Clinic of a tumor depending on localization
Kraniospinalny tumors of an ekstramedullyarny arrangement demonstrate radicular pains of occipital area. Symptoms of defeat of substance of a brain are very variable. Neurologic deficiency in the motive sphere is presented central tetra-or triparezy, the top or lower paraparesis, a cross hemiparesis, in the sensitive sphere — varies from full touch safety to total anesthesia. The symptoms connected with violation of a cerebral likvorotsirkulyation and hydrocephaly can be observed. Trigeminal neuralgia, neuralgia of the facial, yazykoglotochny and wandering nerves is in some cases noted. Kraniospinalny tumors can sprout in a cavity of a skull and cerebral structures.
The new growths of cervical department located at the C1-C4 level give to conduction disorders of sensitivity below of this level and to spastic tetraparesis. Defeat of the C4 level is feature existence of the symptoms caused by diaphragm paresis (short wind, a hiccups, the complicated sneezing and cough). Formations of area of a cervical thickening are characterized by the central lower and atrophic top paraparesis. The tumor of a spinal cord in C6-C7 segments is shown miozy, ptozy and enoftalmy (Horner's triad).
Tumors of chest department give clinic of the surrounding radicular pains. At an initial stage owing to neuroreflex spread of pain to patients often diagnose sharp cholecystitis, appendicitis, pancreatitis, pleurisy. Then conduction touch and motive violations join, belly reflexes drop out. The top extremities remain intact.
The new growths of lumbar and sacral department located in L1-L4 segments are shown by a radicular syndrome, an atrophy of forward group of muscles of a hip, loss of tendinous knee reflexes. Tumors of an epikonus (L4-S2 segments) — peripheral paresis and a gipesteziya in buttocks, a back femoral surface, a shin and foot; incontience of urine and calla. Cone tumors do not lead (S3-S5 segments) to paresis. Their clinic consists of pelvic violations, touch frustration of an anogenitalny zone and loss of an anal reflex.
Tumors of a horse tail differ in slow growth and, thanks to a smeshchayemost of backs, can reach the large sizes, having a subclinical current. Debut the sharp pain syndrome in a buttock and a leg imitating a neuropathy of a sciatic nerve. Asymmetric touch violations, disteel sluggish paresis of legs, loss of Achilles reflexes, an urination delay are typical.
Diagnosis of spinal tumors
The violations revealed during neurologic survey allow the neurologist to suspect organic defeat of spinal structures only. Further diagnostics is carried out by means of additional methods of inspection. The X-ray analysis of a backbone is informative only in the developed disease stage when tumoral process leads to the shift or destruction of bone structures of a spine column.
The fence and research of tserebrospinalny liquid has a certain diagnostic role. Carrying out during a lyumbalny puncture of a number of liquorodynamic tests allows to reveal the block of subarakhnoidalny space. When filling with a tumor of the spinal channel in the field of a puncture, during the research the likvor does not follow (a so-called "dry puncture"), and there is radicular pain caused by hit of a needle in tumor fabric. The analysis of a likvor confirms proteinaceous and cellular dissociation, and is often so expressed that leads to turning of a likvor in a test tube. Detection of tumor cells in tserebrospinalny liquid is rather rare find.
In recent years most of experts refused the applied earlier isotope miyelografiya and a pnevmomiyelografiya in a type of their small informational content and essential danger. To designate the level of spinal defeat, and also to assume extra-or intramedullyarny type of a tumor the contrast miyelografiya allows. However its results are far ambiguous, and carrying out is connected with certain risks. Therefore the miyelografiya is used now only at impossibility of application of the modern neurovisualizing researches.
Backbone MRT acts as the safest and effective way allowing to diagnose a tumor of a spinal cord. The method gives the chance to layer-by-layer visualize the myagkotkanny educations located in a spine column, to analyse the volume and prevalence of a tumor, its localization in relation to substance, covers and backs of a spinal cord, to make preliminary estimate of a gistostruktura of a new growth.
Full verification of the diagnosis with establishment of histologic type of a tumor is possible only after the morphological research of samples of its fabrics. The material intake is usually made for histology during operation. During diagnostic search it is necessary to differentiate a tumor of a spinal cord from a diskogenny miyelopatiya, a siringomiyeliya, a miyelit, arteriovenozny aneurism, a funikulyarny miyeloz, a side amyotrophic sclerosis, a gematomiyeliya, violations of spinal blood circulation, a tuberkuloma, cysticercosis, echinococcosis, a gumma of tertiary syphilis.
Treatment of spinal tumors
Surgical acts as the main effective method of treatment. Radical removal is possible at benign ekstramedullyarny spinal tumors. Removal of a nevrinoma of a back and removal of a meningioma are carried out after a preliminary laminektomiya. Studying of a spinal cord at the microscopic level demonstrates that its defeat at the expense of a sdavleniye ekstramedullyarny education is completely reversible at a stage of a syndrome of Broun-Sekar. Partial restoration of spinal functions can happen also during removal of a tumor in a stage of full cross defeat.
Removal of intramedullyarny tumors very difficult and often involves traumatizing spinal substance. Therefore, as a rule, it is carried out at the expressed spinal violations. At relative safety of spinal functions the decompression of a spinal cord, depletion of a tumoral cyst is carried out. There is a hope that the microneurosurgical method which is taking root into applied medicine will open new opportunities for surgical treatment of intramedullyarny tumors over time. Today from intramedullyarny tumors radical removal is expedient only at an ependimoma of a horse tail, however during removal of an epedimoma there is a risk of damage of a cone. Radiation therapy in relation to intramedullyarny tumors is considered ineffective today, it practically does not affect the low-differentiated astrotsitoma and ependimoma.
Because of the infiltrative growth malignant tumors of a spinal cord are not available to surgical removal. Concerning them also the chemotherapy is possible beam. The inoperable tumor of a spinal cord proceeding with an intensive pain syndrome is the indication to carrying out the antipainful neurosurgical operation consisting in recutting of a spinal back or spinal ways.
The closest and remote forecast of a spinal tumor is defined by its type, an arrangement, structure, term of existence of a compression of a spinal cord. Removal of ekstramedullyarny tumors of good-quality character in 70% leads to total disappearance of the existing neurologic deficiency. At the same time the recovery period varies from 2 months to 2 years. If the spinal compression lasted more than 1 year, it is not possible to achieve a complete recovery, patients become disabled. Mortality of the persons which underwent removal ekstramedullyarny arakhnoendoteliy does not exceed 1-2%.
Intramedullyarny and malignant spinal tumors have adverse prospect as their treatment is only palliative.