Preoperative assessment of intramedullary lesion length has become part of a planning algorithm for decompression surgery. In degenerative cervical myelopathy, intramedullary signal abnormalities on MRI often reflect ongoing biological activity rather than fixed tissue loss. As compression persists, reduced perfusion and altered cerebrospinal fluid dynamics may create a compartment-like intradural environment in which the spinal cord has limited reserve capacity. The goal of surgery remains restoration of a permissive intradural environment for the spinal cord. Intraoperative adjuncts such as ultrasonography or assessment of dural pulsatility may help verify adequacy of decompression.
This systematic review analyzed treatment strategies and outcomes for spinal low-grade gliomas, based on data from 63 studies encompassing 954 patients. Surgery was the primary treatment, with gross total or subtotal resection associated with improved survival. Subtotal resection followed by radiotherapy prolonged progression-free survival. Fractionated radiotherapy (45-50 Gy) showed disease stabilization and neurologic improvement, with some studies reporting a 5 year progression-free survival of 93% and an overall survival of 100%. Chemotherapy was mainly used in recurrent cases. Prognosis varied by histology; pilocytic astrocytomas showed excellent survival, while infiltrative gliomas were linked to poorer long-term outcomes.
Intramedullary spinal cord lesions represent a rare, clinically consequential group of pathologies where imaging plays a decisive role in diagnosis, operative planning, and longitudinal management. MRI remains the cornerstone of evaluation, providing critical information regarding lesion localization, extent, internal composition, and relationship to functional spinal cord pathways. Advanced MRI techniques including diffusion tensor imaging, susceptibility-weighted imaging, and intraoperative ultrasound have expanded the neuroradiologic toolkit but have limitations, particularly in pediatric patients. This review focuses on the neuroradiologic evaluation of intramedullary spinal cord lesions, imaging technical considerations, pattern recognition, and practical pearls relevant to neurosurgeons and neuroradiologists managing these challenging entities.
Intramedullary spinal cord tumor surgery has evolved through major technological advances. From early attempts in the 19th century to modern methods, innovations like the operative microscope, bipolar coagulation, and MRI have transformed practice. The introduction in the 1980s of intraoperative neurophysiological monitoring enabled real-time spinal cord functions assessment through the application of monitoring techniques. In this article, we will review the state of the art of the different techniques, the alarm criteria and related recovery strategies, current controversies and future considerations.
