Objective: Intramedullary melanocytomas are extremely rare spinal cord tumors with distinct histopathological and imaging characteristics. This report reviews the literature on this pathology and presents a representative case study, highlighting aspects of diagnosis and management. Methods: A scoping review of PubMed, Web of Science, and Embase databases was conducted to identify reports on intramedullary melanocytomas, focusing on clinical presentation, imaging features, histopathology, treatment, and outcomes. Case reports and case series were included due to the rarity of these tumors. Results: Twelve manuscripts met the inclusion criteria, including 15 patients. In the majority of patients, intramedullary melanocytomas present with progressive myelopathy and pain. Most common MRI findings include hyperintensity on T1-weighted images, iso- to hypointensity on T2-weighted images, and homogeneous contrast enhancement. Intralesional cysts and associated syrinx are common. Gross total resection (GTR) remains the primary treatment, but complete removal is often challenging due to tumor adherence to neural structures. Conclusions: Intramedullary melanocytomas require careful diagnosis and management due to their diagnostic overlap with malignant melanoma and potential for recurrence. While GTR is the mainstay of treatment, long-term surveillance is warranted due to high recurrence rates. Further research is needed to define the natural history of the disease and establish optimal therapeutic strategies.

BACKGROUND AND OBJECTIVES: Preoperative imaging provides surgeons with an initial estimate of tumor infiltration and the likelihood of achieving an en-bloc resection in spinal cord ependymomas, yet the definitive decision is made intraoperatively. This study characterizes the intraoperative ultrasound (iUS) features that guide real-time surgical strategy and are associated with successful en-bloc removal. METHODS: A retrospective review of iUS images obtained during resection of spinal cord ependymomas was performed. The presence of a peritumoral halo representing the transition zone between the tumor and the spinal cord, the dorsal sagittal area of the spinal cord overlying the tumoral poles, the presence and location of tumor cysts, and the diameter of the compressed spinal cord located ventral and dorsal to the tumor were assessed. Demographic and surgical data including extent and technique of resection, occurrence of intraoperative neurophysiological changes, and preoperative and postoperative neurological status were collected. RESULTS: The mean dorsal sagittal area of the spinal cord overlying the cranial pole was 0.1 cm ² (range 0-0.23 cm ² ), whereas the area overlying the caudal pole was 0.05 cm ² (range 0-0.16 cm ² ). All tumors exhibited a peritumoral halo, ranging from 0° to 360° in the axial view. The echogenicity of the halo was predominantly hypoechoic. Gross total resection was achieved in all cases, with en-bloc technique performed in 57% of patients. Intraoperative changes in somatosensory and motor evoked potentials were observed in all cases. Nevertheless, clinically, all patients remained neurologically stable in the postoperative period compared with preoperative. CONCLUSION: iUS identifies useful imaging features that allow surgeons to develop a structured resection plan before spinal cord manipulation. Future longitudinal studies are needed to validate whether the presence of a peritumoral halo or the extent of sagittal spinal cord area overlying the tumor poles are predictors of neurological and oncological outcomes.

Background and Objectives: Up to 40% of patients with cancer develop spinal metastases, and stereotactic spinal radiosurgery (SSRS) achieves high local control rates as definitive or postoperative treatment. Multiple tumor response assessments have been used but their compared clinical performance in post-surgical patients remains unclear. We sought to compare the applicability of RECIST1.1, MDACC and SPINO criteria. Materials and Methods: This IRB-approved retrospective study included patients with high-grade epidural spinal cord compression treated with decompressive surgery followed by adjuvant SSRS, with MRI follow-up available. Lesions were classified according to each of the scale’s objective (RECIST1.1 and MDACC) and subjective (SPINO [radiology reports]) criteria. Results: Ninety-four treated levels in 93 patients (median age 58.9 years) were analyzed. Most metastases were thoracic, and all cases had preoperative high-grade epidural spinal cord compression. Adjuvant SSRS was delivered in one or three fractions. Median follow-up was 16 months (range, 1–132), SPINO-based assessment was feasible in 100% of cases, RECIST1.1 in 43.6% and MDACC in 46.8%. Progressive disease criteria were met in 21.3% of cases using SPINO-based assessment, 19.5% using RECIST1.1, and 6.8% using MDACC. Conclusions: The SPINO recommendations provide a practical and comprehensive framework for radiographic response assessment in monitoring spinal metastases treated with a combination of surgical decompression and adjuvant SSRS.