CRANIOSPINAL TUMOURS (grech, kranion skull + lat. spinalis spinal) — the tumors of substance, roots and covers of a head and spinal cord which are localized in the field of a big occipital opening, located a part in a cavity of a back cranial pole, a part in a cavity of the vertebral channel. Treat them tserebellospinalny, bulbospinalny, spinomedullyarny, spinobulbarny, etc. tumors. This group of tumors allocated by the topografo-anatomic principle includes new growths various structural morfol. properties, character and direction of growth. In it allocate the tumors arising at the level of a big occipital opening, and also growing into it from a back cranial pole from top to bottom or from the vertebral channel up and the tumors which are located ekstramedullyarno, intramedullyarno or intraekstramedullyarno (fig., 1 — 2).
Intracerebral tumors, usually glial nature, extend to an oblong and spinal cord, often occupying all its diameter (fig., 4). Extra brain tumors — meningioma (see), neurinoma (see), more rare chondroma (see), sometimes lipoma (see) — can be located ahead, sideways or behind a brain. The group inside - extra brain tumors is made generally ependymomas (see) and astrocytomas (see), coming from elements of a bottom or a roof of the IV ventricle, filling his cavity, getting through a median aperture of the IV ventricle (Marangdi's opening) into the cerebellar and brain tank further extending to the spinal canal along a spinal cord (fig., 3). These tumors in relation to an oblong and spinal cord are located dorsalno and only in rare instances can shroud them in the form of the coupling. Various options of classifications of these tumors are offered by D. K. Bogorodinsky (1931), M. A. Salazkin (1953), E. Ya. Shalamai (1969).
To. lakes are observed at people of all age. For the first time To. the lake described N. Antoni on the anatomic drug which is stored in the Lund museum (Sweden) in 1862. Then in 1867 Mr. Schuppel described a glioma of this localization, and in 1874 F. Allopo — an extramedullary tumor. In domestic literature To. the lake it is for the first time described by V. V. Kramer (1911). The first monograph on this subject is written by D. K. Bogorodinsky (1936).
Clinical picture depends on extent of damage of lower parts oblong and upper parts of a spinal cord. The first manifestations and the sequence of development of symptoms depend on the place of primary developing of a tumor, its preferential localization and the further direction of growth. The arrangement of a tumor in relation to diameter back and a myelencephalon matters also. Along with focal symptomatology all-brain symptoms appear. In the same cases when the disease leads to development of occlusion at the level of a back cranial pole, into the forefront the gipertenzionno-gidrotsefalny syndrome acts (see. Occlusal syndrome ).
At extramedullary To. islands, localized preferential in upper parts of a spinal cord, initial symptoms usually are widespread radicular pains in cervicooccipital area of the burning, squeezing character to broad irradiation in shoulder girdles, shovels, interscapular area. Duration of the period of radicular pains without accession of any other symptoms attracts attention. During a row of months, and sometimes and years patients continue to work and are only periodically treated concerning these pains usually with the diagnosis of a cervical miositis, radiculitis, an arachnoiditis of a spinal cord and so forth. Further paresthesias in fingers of hands join radicular pains, is more often in one hand on the party of a tumor, and only in the subsequent there are motive disturbances. There is a certain pattern in emergence of paresis of extremities: in the beginning weakness in a hand on the party of a tumor, then paresis of a leg on the same party then arises triparez and, at last, after emergence of weakness in a hand on the party opposite to a tumor, forms a wedge, a picture of tetraparesis. Along with development of motive disturbances there are symptoms of damages of cranial nerves (bulbar group). Unlike tumors of a spinal cord of cervical localization, disturbance of sensitivity of both radicular and segmented, and conduction character are not Pathognomonic for extramedullary To. lake. In developed a wedge, a picture extramedullary To. islands into the forefront act the expressed motive disturbances, is frequent in the form of sluggish paresis in hands and a spastic paraparesis in legs, with dysfunctions of sphincters of pelvic bodies; appear Bernard's syndrome — Horner (see. Bernard — Horner a syndrome ), a sharp radicular pain syndrome with forced position of the head. The phenomena of intracranial hypertensia are, as a rule, more expressed with the descending growth of a tumor, than at ascending.
At intramedullary To. the lake, unlike extramedullary tumors, a disease begins with emergence of paresthesias in hands, is more often in one, and peculiar pain in a neck, a nape, shoulder girdles and upper extremities. These pains differ from radicular in the stupid, aching character, uncertain irradiation. In process of development of a disease motive frustration — weakness in a hand, then in a leg on one party appear in the beginning. At the same time there are sensitive frustration having type of the segmented dissociated disturbance of sensitivity. There are symptoms of defeat of bulbar group of cranial nerves a bit later, and they are always expressed softly, though remain steady. Disturbances of sensitivity in zones of an innervation of a trifacial on nuclear type are quite often observed. Considerably more often than at extramedullary tumors, it is noted spontaneous horizontal nystagmus (see). Disturbances of functions of pelvic bodies appear much earlier, than at extramedullary tumors.
The first symptoms of a disease at patients inside - extra brain To. lakes are signs of defeat of formations of a back cranial pole, generally symptoms of the increased intracranial pressure (see. Hypertensive syndrome ). Along with it also the symptoms resulting from impact of a tumor on the educations located in day of the IV ventricle — nausea, vomiting, dizzinesses are observed. Further development of symptoms of a disease consists in increase of the general gipertenzionno-gidrotsefalny phenomena against the background of which these or those trunk or cerebellar symptoms come to light.
Expressed a wedge, symptoms of intramedullary tumors have much in common with symptoms of extramedullary new growths of the same level, and differential diagnosis represents them a difficult task.
At intracerebral tumors usually at the same time is surprised both a cervical part of a spinal cord, and a trunk part of a brain. The analysis of symptoms, dynamics of their development, and also usual roentgenograms can provide the correct diagnosis only regarding cases. Use of X-ray contrast researches specifies idea of localization of a tumor, but often does not give the grounds for the solution of a question about out of - or its intracerebral arrangement. In some cases exact localization To. the lake can be defined only during operation. At a research of cerebrospinal liquid at To. the lake is defined proteinaceous and cellular dissociation, edges in some cases can be combined with a xanthochromia. Liquorodynamic disturbances are noted approximately equally often both at inside - and at extra brain new growths.
by the Main method of treatment To. the lake is operational. As the indication to operation serves increase nevrol, the frustration caused by a tumor. The difficulties connected with operational treatment of craniospinal new growths are explained first of all by topografo-anatomic features of an arrangement of a tumor, existence of the general sources of blood supply of a tumor and the vital departments located in a brainstem, a condition of patients heavy in most cases in the preoperative period, etc. Improvement of diagnosis, surgery in early terms later began diseases, improvement of the technology of carrying out operation, widespread introduction in practice sovr, types of anesthesia allowed to expand indications to operation, to improve the immediate and long-term postoperative results.
The choice of this or that operational access at To. the lake depends on the level of its arrangement and extent. Operative measures are carried out in sedentary or lying (on a stomach or on one side) position of the patient. At intramedullary tumors in the postoperative period carrying out a deep roentgenotherapy is recommended.
Optimum results at operational treatment are observed at the ascending extra brain tumors, and also at a part of patients with inside - extra brain new growths at which it is possible to remove a tumor almost completely. The greatest technical difficulties and often not very comforting results of operations are observed at the descending extra brain tumors (especially meningiomas) located on an internal slope of a base of skull and also at infiltrative growing intracerebral new growths.
The disturbances of breath and cordial activity resulting from development of anatomic changes in a brainstem are the main reason for death of patients after operation.
Bibliography: Arseni K. and Simionesku of M. Neurosurgical verte-bromedullyarny pathology, the lane from Romanians., page 203, Bucharest, 1973; B from about r about d and nanosecond to and y D. K. Sindr of a craniospinal tumor, Tashkent, 1936, bibliogr.; Stanislavsky V. G. Meningiomas of a back cranial hole, page 192, Kiev, 1976; Cohen L. Tumors in the region of the foramen magnum, Handbook clin, neurol., ed. by P. J. Yinken a. G. W. Bruyn, v. 17, pt 2, p. 719, Amsterdam — N. Y., 1974, bibliogr.; Grundriss der Neuroradiologie, hrsg. v. I. Neumann u. K. Seidel, Lpz., 1976; Stein B. M. a. o. Meningiomas of the foramen magnum, J. Neurosurg., v. 20, p. 740, 1963.
A. P. Romodanov.