Objective. Primary intramedullary spinal
germ cell tumors are exceedingly rare. As such, there are no established treatment paradigms. We describe our management for spinal
germ cell tumors and a review of the literature. Clinical Presentation. We describe the case of a 45-year-old man with progressive lower extremity weakness and sensory deficits. He was found to have enhancing intramedullary mass lesions in the thoracic spinal cord, and pathology was consistent with an intramedullary
germ cell tumor. A video presentation of the case and surgical approach is provided. Conclusion. As spinal cord
germinomas are highly sensitive to radiation and
chemotherapy, a patient can be spared radical surgery. Diverse treatment approaches exist across institutions. We advocate biopsy followed by local radiation, with or without
adjuvant chemotherapy, as the optimal treatment for these
tumors. Histological findings have prognostic value if syncytiotrophoblastic giant cells (STGCs) are found, which are associated with a higher rate of recurrence. The recurrence rate in STGC-positive spinal
germinomas is 33% (2/6), whereas it is only 8% in STGC-negative
tumors (2/24). We advocate limited volume
radiotherapy combined with systemic
chemotherapy in patients with high risk of recurrence. To reduce endocrine and neurocognitive side effects, cranio-spinal radiation should be used as a last resort in patients with recurrence.