Semin Neurol 2012; 32(02): 137-145
DOI: 10.1055/s-0032-1322584
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neoplastic Myelopathy

Seema Nagpal
1  Division of Neuro-oncology, Department of Neurology, Stanford University, Stanford, California
,
Jennifer L. Clarke
2  Department of Neurology and Neurosurgery, University of California, San Francisco, California
› Author Affiliations
Further Information

Publication History

Publication Date:
08 September 2012 (online)

Abstract

Neoplastic myelopathy may be due to external compression or to direct intraparenchymal involvement of the spinal cord. In this review, the authors discuss the most common cause for compressive neoplastic myelopathy, metastatic disease. They also review other compressive lesions and discuss primary intramedullary spinal tumors. In the acute setting, compressive metastatic disease should be treated with high-dose steroids when clinically necessary; surgery should be considered for selected patients, followed by radiation therapy. For most primary intramedullary spinal tumors, surgical resection remains the standard initial therapy. Patients with incomplete resection of infiltrative tumors, high-grade pathology, or recurrent tumors may benefit from radiation, but most spinal tumors are relatively insensitive to traditional chemotherapy. Neoplastic myelopathy from either compressive or intraparenchymal causes remains a diagnostic and therapeutic challenge. In complex cases, referral to a specialty center with access to neurosurgeons, neuroradiologists, neuropathologists, and neurooncologists is recommended.