Spinal Cord Glioblastoma Multiforme
- Background: Glioblastoma multiforme (GBM) represents 7.5% of all intramedullary gliomas and 1–3% of all spinal cord tumors. Intramedullary GBM may occur as a primary spinal cord neoplasm or secondary due to metastasis from a brain GBM. Primary lesions have a predilection to the cervical region and for patients younger than 30 years old.
- Clinical Presentation: Very aggressive lesion, with survival ranging from 6–16 months.
- Key Diagnostic Features:
- MRI is the imaging modality of choice, although it is not specific. MRI demonstrates a T1-hypointense and T2-hyperintese intramedullary expansile lesion, with various degrees of irregular and poorly defined enhancement.
- Diffusion tensor imaging and perfusion can aid in the diagnosis with decreased fractional anisotropy (FA) and increased relative cerebral blood volume (rCBV).
- Biopsy is necessary to make the correct diagnosis.
- DDx: May be indistinguishable from fibrillary astrocytoma and ependymoma (the 2 most common intramedullary neoplasms) on conventional imaging. There are some reports that suggest that high-grade neoplasms have less enhancement in the spinal cord, specially those in the region of the conus medullaris.
- Treatment: Treatment is based on radiotherapy and chemotherapy, with poor survival rates, as mentioned above. Surgery is reserved mainly for biopsy and debulking of tumor, but gross resection is not possible.
