Benign spinal cord tumors (SCTs) are uncommon neoplasms that can arise within or adjacent to the spinal cord. Depending on their anatomical location, benign SCTs can be categorized as intramedullary, intradural-extramedullary, and extradural. The three most common benign SCTs are meningioma, nerve sheath tumors, and ependymoma. Both meningioma and nerve sheath tumors develop in the intradural-extramedullary compartment, while ependymoma occurs in the intramedullary space. Spinal meningiomas derive from arachnoidal cells and most commonly occur within the thoracic segment of the spine. Nerve sheath tumors, including schwannomas and neurofibromas, are closely associated with spinal nerves. Half of the spinal cord ependymomas arise in the lumbosacral segment or the filum terminale. Surgical treatment of large or symptomatic benign SCTs concentrates on total or subtotal resection of the tumors, which should be cautiously individualized based on the tumor location and histopathology. A curable complete resection should be achieved if possible while preserving the nervous function of the spinal cord and minimizing potential complications. Thoracic spinal roots may be sacrificed to acquire a total resection, yet cervical and lumbar nerve roots should be preserved prudently. Due to the vulnerable and complex anatomic nature of the spinal cord, maximal resection of the tumors can be achieved with the aid of appropriate intraoperative neural monitoring and meanwhile preserve nervous function.
Part of the book: Cancer Immunotherapy and Biological Cancer Treatments