Sixty-six patients had surgery for an intramedullary nerve sheath tumour under the care of one surgical team in a 16-year period. Surgery concentrated on radical intra- and extradural excision combined if necessary with vertebral column reconstruction. Ninety procedures were used in 35 males and 30 females with an age range 12-81 years. Forty-five per cent were located in the cervical, 26% in the thoracic and 29% in the lumbosacral region. Eighteen patients had NF1 and two patients NF2. Sixty-five per cent were schwannomas, 27% were mixed histology and 6% malignant. In terms of functional outcome, 37 patients improved by one or more Frankel grades, three deteriorated by one Frankel grade and no one who presented with symptoms alone deteriorated. There were no operative deaths; no instrumentation failures and five patients developed a CSF leak.
The results of surgical management in 54 patients with intramedullary spinal cord tumours are presented. Cervical tumours were most frequent (25/54) followed by thoracic (16/54) and then lumbar (14/54). Ependymomas and astrocytomas were the most common tumour types. Total tumour removal was possible in just over half of the cases. Surgical complications included: two deaths, six patients with CSF leaks and one with wound infection. Postoperatively three patients had worsening of their motor deficit (unable to walk) and three patients had worsening of urinary sphincter function. Conversely, three patients who were unable to walk preoperatively were able to walk postoperatively, whilst four patients with sphincter disturbance showed improvement. Total tumour removal was not associated with increased risk of postoperative neurological deficit. Long-term follow up (2-18 years) was possible in 40 patients; 90% were still independently mobile. Our results compare favourably with other European studies and data from the North American units which have pioneered this surgery.
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