Feasibility for Intramedullary Spinal Glioma
Spinal cord tumors are lesions that occur within or adjacent to the spinal cord. They are considered to be intra-axial in location and can be either primary or metastatic. Spinal cord tumors are relatively rare and account for 2 % of all central nervous s
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Kei Nakai and Akira Matsumura
Contents 23.1 Introduction ................................................................................................................. 407 23.2 Actual State-of-the-Art Treatment ............................................................................ 408 23.3 Rationale for BNCT .................................................................................................... 409 23.4 Technical Aspects and Results ................................................................................... 409 23.4.1 Anteroposterior and Posteroanterior Irradiation ............................................. 409 23.4.2 Lateral and Oblique Irradiation ....................................................................... 413 23.5 Level of Evidence......................................................................................................... 414 23.6 Further Development .................................................................................................. 414 References ..............................................................................................................................
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Introduction
Spinal cord tumors are lesions that occur within or adjacent to the spinal cord. They are considered to be intra-axial in location and can be either primary or metastatic. Spinal cord tumors are relatively rare and account for 2 % of all central nervous system tumors. Tumors arising within the spinal cord itself are called intramedullary tumors, one-third of which are located in the intramedullary compartment [1, 2]. The spinal cord has the characteristic of integrated neuronal axons existing within a small diameter. Since spinal cord pathways are interrupted, neurologic dysfunction may be produced distally. Major complaints of the patients are unremitting pain, sensory dysesthesia, and muscular weakness. K. Nakai (*) • A. Matsumura Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan e-mail: [email protected] W.A.G. Sauerwein et al. (eds.), Neutron Capture Therapy, DOI 10.1007/978-3-642-31334-9_23, © Springer-Verlag Berlin Heidelberg 2012
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K. Nakai and A. Matsumura
The majority of intramedullary tumors are gliomas, either ependymomas or astrocytomas. Spinal ependymomas are associated with a significantly better prognosis than both supratentorial and infratentorial tumors, particularly when complete resection is possible. According to McGuire et al., the 5-year survival was reported as 86.6 % of the 55 spinal ependymoma cases [3]. Postoperative radiotherapy may be useful when complete resection cannot be achieved, but both early and delayed relapses can occur. Spinal astrocytomas are similar to intracranial astrocytomas; the clinical course of these astrocytic lesions can be predicted by their pathologic features: long-term survival is related to tumor grade. A recent report showed that the median overall survival of the patients with spinal anaplastic astro
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