Epidemiology Primary central nervous system (CNS) tumor of the spine is classified as intradural extramedullary intradural intramedullary extradural Epidemiology primary CNS tumors most common intracranially 2-4% occur in the spine 850-1,700 diagnosed in United States annually Intradural Extramedullary Tumors Epidemiology account for 60-70% of all primary CNS spinal cord tumors typically present with symptoms related to central cord compression radicular pain deep seated back pain login to view 1 more bullet associated cauda equina-like symptoms Schwannoma incidence most common intradural tumor along with meningiomas peak incidence in 40s-50s equal occurrence between men and women most are benign, with malignant subtypes arise from dorsal nerve root may be associated with login to view 1 more bullet imaging MRI exhibits mass arising from dorsal root login to view 2 more bullets common locations: login to view 5 more bullets histology difficult to distinguish from neurofibroma biphasic, Antoni A (hypercellular) and B (hypocellular) pattern elongated nerve cells in collagen background S-100 positive treatment surgical resection post-operative radiation for malignant tumors Meningioma incidence accounts for 25% of all primary spinal cord tumors most often occurs in: login to view 2 more bullets peak incidence during 5th and 6th decades of life risk factors include: login to view 2 more bullets imaging MRI login to view 3 more bullets histology lobulated architecture may contain meningothelial whorls treatment if symptomatic, surgical resection can be curative with complete resection for recurrence, radiation should be considered Intradural Intramedullary Tumors Epidemiology account for 20-30% of all intradural tumors in adults and 50% in children typically present with symptoms related to: local or radicular pain motor deficits (65%) sensory deficits (60%) sphincter dysfunction (38%) login to view 1 more bullet Ependymoma incidence most common intradural intramedullary primary CNS tumor classified as: login to view 5 more bullets imaging myxopapillary login to view 9 more bullets cellular login to view 4 more bullets histology cellular, monomorphic cells characteristic rosettes and pseudorosettes treatment gross total resection login to view 1 more bullet Astrocytoma incidence most are benign (30%) peak incidence in third decade of life most common in children (80-90% of intramedullary tumors) imaging on MRI login to view 4 more bullets histology hypercellular, mitotic figures eosinophilic granules are common treatment gross total resection difficult due to infiltrative nature radiation typically used to supplement surgery chemotherapy may be beneficial Extradural Tumors Metastasis extramedullary representative of advancing systemic disease 'drop' metastases from cranial lesion possible login to view 1 more bullet intramedullary rare, <1% of all systemic malignancies most commonly from: login to view 2 more bullets imaging rapidly expanding, progressive on MRI intramedullary commonly found in cervical region and conus medullaris treatment surgical resection rare control burden with radiation and/or chemotherapy intramedullary metastases associated with less than 3 month life expectancy Lymphoma incidence rare imaging entire neuroaxis should be analyzed via MRI on T2, ill-defined hyperintense lesion with marked homogeneous contrast enhancement less cord enlargement usually found in cervical spine treatment methotrexate