Intramedullary Spinal Cord Tumours

I believe it is important to be upfront about this. Surgery within the substance of the spinal cord is one of the most demanding areas of spinal surgery, and it is not something I take on. In my view it should be carried out by surgeons who specialise in it and perform it in high volume, because that experience directly affects how safely the tumour can be removed and how well the cord is protected. So if an intramedullary tumour is found, my role is to recognise it, ensure the right imaging is obtained, and refer you without delay to an expert in spinal cord tumour surgery. What follows explains the condition itself.

Because the tumour grows within the cord, symptoms come from disturbance of the cord's function and usually develop gradually over months. Common features include pain — often a deep, aching or burning pain, sometimes worse at night — along with numbness or altered sensation, weakness, clumsiness, problems with balance and walking, and, as things progress, bladder or bowel symptoms. The pattern depends on the level of the cord involved. Because these symptoms build up slowly and can be subtle at first, the diagnosis is sometimes delayed, which is another reason that prompt, accurate assessment and imaging matter.

The essential investigation is an MRI scan with contrast, which shows the tumour within the cord, its extent, and features that help suggest its type — for example, whether it is likely to be an ependymoma, an astrocytoma or a haemangioblastoma. This imaging is central both to diagnosis and to the specialist surgeon's planning. My part is to make sure this imaging is arranged quickly and interpreted correctly so that you reach the right specialist promptly and with the right information.

The mainstay of treatment for many of these tumours is careful microsurgical removal by a spinal cord tumour specialist, using an operating microscope and continuous nerve-function monitoring — such as motor evoked potentials — to protect the cord during surgery. How much of the tumour can safely be removed depends on its type and how clearly it separates from the surrounding cord: some, such as many ependymomas and haemangioblastomas, have a plane that allows complete removal, while others, such as certain astrocytomas, are more infiltrative and are approached more cautiously, sometimes with a role for additional treatments. The published evidence shows that monitoring during surgery and the extent of resection are important to outcome, and that results are best in experienced, high-volume hands. This is precisely why I refer these cases on.

The outlook varies with the tumour type, its extent, and the state of the cord before surgery. Where a tumour separates cleanly and is removed completely by an experienced specialist, the outlook can be very good, and preserving neurological function is a central goal of modern surgery with monitoring. Recovery from any disturbance of the cord takes time and is supported by rehabilitation. My priority is to recognise the tumour early, protect you from delay, and place you in the right specialist hands.

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