Which primary malignancies cause cauda equina syndrome (CES)?

Updated: Jun 14, 2018
  • Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

Cauda equina syndrome can be caused by primary or metastatic spinal neoplasms. Among the primary tumors able to cause CES include myxopapillary ependymoma, schwannoma, and paraganglioma.

Myxopapillary ependymoma is the most common tumor of the filum. Recovery of the function after surgery depends on the duration of symptoms and the presence or absence of sphincter dysfunction [48] Paraganglioma of the filum, when present, needs to be differentiated from other tumors of this region. [49] Although rare, this entity may present as CES.

Schwannomas are benign encapsulated neoplasms that are structurally identical to a syncytium of Schwann cells. [50] These growths may arise from peripheral or sympathetic nerves. Schwannomas, whether solitary or as a part of a syndrome, may cause CES if present at the level of the conus or filum terminale. Primary tumors that affect the sacrum, such as chordoma and giant cell tumor of the bone, may produce similar symptoms as a result of bony destruction and collapse. [51]

Ependymomas are gliomas derived from relatively undifferentiated ependymal cells. They often originate from the central canal of the spinal cord and tend to be arranged radially around blood vessels. Ependymomas are found most commonly in patients aged approximately 35 years. They can lead to increased intracranial pressure (ICP), and cerebrospinal fluid (CSF) has an increased protein level.

Metastatic lesions of the spine are being reported with increasing frequency because of earlier diagnosis, better imaging, and more effective treatment modalities. Although metastasis accounts for most tumors in the spine in general, metastatic tumors in the cauda equina are relatively rare compared with primary tumors.


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