O.A. Perlmutter1, A.V. Yarikov1–3, A.O. Dubsky4, I.A. Lobanov1, I.V. Gunkin5, A.P. Fraerman1, S.N. Tsybusov3, V.A. Loktionov6
1City Clinical Hospital No. 39, Nizhny Novgorod
2Volga Regional Medical Center, Nizhny Novgorod
3National Research Nizhny Novgorod State University named after N.I. Lobachevsky, Nizhny Novgorod
4Sverdlovsk Regional Oncological Dispensary, Yekaterinburg
5Mordovian Republican Central Clinical Hospital, Saransk
6Volga Region Research Medical University, Nizhny Novgorod
Perlmutter Olga A. — MD, professor, honored doctor of the Russian Federation, neurosurgeon
City Clinical Hospital No. 39
144 Movskovskoe highway, tel.: 89107934207e-mail: oaperlmutter@gmail.com SPIN-код: 1243-9601, ORСID ID: 0000-0002-7934-1437
Abstract. Intramedullary tumors of the spinal cord constitute a smaller proportion of primary tumors of the central nervous system (10–20%), but represent a variety of masses of different histological nature. This paper reviews the classification of intramedullary tumors of the spinal cord with a description of epidemiological, histological, and morphological features. Clinical manifestations with variants of progressive, remitting and stroke-like course are described further: nocturnal protopathic pain, descending type of conductive sensory disturbances, muscle atrophy, spasticity, increased tendon reflexes, pathological foot signs, pelvic organ dysfunction. The importance of using MRI-neuroimaging protocols in the diagnosis of intramedullary tumors of the spinal cord is noted, which allow to determine the structure, localization, severity of spinal cord deformation, the degree of stenosis of the spinal cord canal, the presence of volumetric impact on the surrounding structures, the involvement of bone structures, spinal cord sheaths, epidural tissue and paravertebral soft tissues in the process at the preoperative stage. The methods of treatment used are reviewed: surgical treatment, radiation therapy and chemotherapy. Emphasis is placed on the importance of following the basic principles of surgical treatment according to the morphologic forms of intramedullary spinal cord tumors. Possible complications are described. The importance of additional use of rehabilitation programs in the early postoperative period is noted, including both physical and psychological methods of influence in order to improve the quality of life, increase functional status and prevent possible complications.
Key words: intramedullary tumors, ependymoma, astrocytoma, myelotomy, hemangioblastoma, intraoperative monitoring.