Adult intramedullary astrocytomas of the spinal cord

Epstein, Fred J.; Farmer, Jean‐Pierre; Freed, Diana

doi:10.3171/jns.1992.77.3.0355

Cited by 225 publications

(105 citation statements)

References 16 publications

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“…1,2,10 Reports regarding the selection of the surgical procedure varied from those encouraging aggressive resection 11,12 to those claiming that a biopsy may result in a better functional outcome; 1,2,10,13 and this issue remains controversial. During the past 10 years, we have attempted vigorously to totally remove astrocytomas whenever possible.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of intramedullary spinal cord tumors: prognosis and complications

et al. 2007

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Study design: Retrospective case series. Objective: To evaluate our recent treatment strategy for intramedullary spinal cord tumors. Setting: Department of Orthopaedic Surgery, Keio University, Japan. Methods: We reviewed 68 cases of intramedullary tumors (ependymoma, 33; astrocytoma, 23; hemangioblastoma, 12), treated surgically between 1994 and 2003. There were 42 males and 26 females whose mean age at the time of surgery was 43 years. The mean follow-up period was 6.2 years. The tumor malignancy grade according to the WHO classification was astrocytoma grade I, 3; grade II, 8 (low-grade: 11 cases); grade III, 10; grade IV, 2 (high-grade: 12 cases). All ependymomas were grade II. Three of the 12 hemangioblastomas were associated with von Hippel-Lindau disease. Results: Total excision was achieved in 90% of the ependymomas and functional improvement was obtained when the preoperative neurological deficit was mild. Approximately 50% of low-grade astrocytomas could be totally excised with favorable survival outcomes, suggesting that total excision should be attempted for low-grade astrocytomas. However, total excision of high-grade tumors was difficult and the functional outcomes were poor. Cordotomy should be considered in patients with a thoracic high-grade astrocytoma. Total resection was possible in 92% of hemangioblastoma, and the functional outcomes were good, however, more attention should be paid for tumors with feeding arteries on the ventral side and for those associated with von Hippel-Lindau disease. Conclusions: Predictors of good surgical outcome for intramedullary spinal cord tumors were histological grades of the tumors, surgical margins, and neurological status of the patient before surgery.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of intramedullary spinal cord tumors: prognosis and complications

et al. 2007

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“…Also, one category B study reported significantly better 10-year OS in patients receiving GTR or PR when compared to biopsy only [51]. In addition, in the study of Epstein (category A), where all 17 patients received GTR, no recurrence was observed during a mean follow-up of 50 months [15].…”

Section: Syrinx/cyst Presencementioning

confidence: 98%

“…Results for EOR specifically for HG histology were reported in nine studies, four were classified as category A [5,15,34,46], five as category B [11,27,51,52,65] (Table 13, lower part). Only one category A study reported increased 4-year OS in anaplastic astrocytoma (grade III) patients [46]; those receiving GTR had significantly improved survival (78% at 5 years) when compared to patients with STR (38% at 5 years, p = 0.028).…”

Section: Syrinx/cyst Presencementioning

confidence: 99%

Prognostic factors in intramedullary astrocytomas: a literature review

2009

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Astrocytomas affect a significant portion of patients with intramedullary tumors. These infiltratively growing tumors are treated by a variety of methods-biopsy and decompressive surgery, maximal safe resection, adjuvant oncological therapy. Also, numerous prognostic factors are reported in the literature. Better understanding of factors that influence prognosis may help in treatment planning with the goal of prolonging survival. We have thus undertaken an extensive literature review in order to define factors affecting prognosis. A total of 38 articles were studied. Only tumor grade was consistently reported as the major factor affecting prognosis. The influence of other clinical factors (age, gender, history length, functional status, tumor location or extent, syrinx or cyst presence) can be speculated upon, but cannot be assessed adequately from the available literature. For both low-and high-grade (HG) astrocytomas, maximal safe tumor resection should be the primary treatment objective but is often not feasible in contrast to other intramedullary and spinal neoplasms. Since the biological nature of spinal cord HG glioma is identical to that of the brain, the same treatment algorithm of maximal safe resection followed by concomitant radio-and chemotherapy would be sensible to implement.

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“…[1][2][3] Because of the rarity of this tumor, optimal treatment guidelines have yet to be defined. The traditional treatment strategy for intramedullary astrocytoma is a biopsy to confirm the diagnosis followed by radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

“…4 However, the efficacy of this treatment has been a subject of controversy. Important but presently unsettled issues include the impact of the extent of resection on local control and survival 1,5,6 and the significance of postoperative radiation therapy. 7 The purpose of the present study was to obtain useful information to establish decision-making guidelines for the treatment of spinal cord astrocytoma by examining the clinical records of patients treated at Keio University Hospital.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcomes of spinal cord astrocytomas

et al. 2006

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Study design: Retrospective case series.Objectives: To analyze prognostic factors for patients with spinal cord astrocytomas. Setting: Department of Orthopaedic Surgery, Keio University, Japan. Methods: Seven patients received total excisions (group T), eight underwent partial excisions (group P), and 15 had excisional biopsies (group B). Impacts of the tumor histological grade, the level of the tumor, the types of surgical interventions, and the use of adjuvant radiotherapies on the survival and functional outcomes of 30 patients (18 in low-grade and 12 high-grade malignancy tumors) were analyzed. Results: The survival rate of the low-grade malignancy group was significantly higher than that of the high-grade group. The survival rate of the patients with thoracic astrocytomas was significantly higher than those with cervical astrocytomas. In both the low-and high-grade groups, the survival rates in groups P/T were significantly higher than those in group B. In the low-grade group, five patients, whose preoperative functional statuses were classified as 'fair' or better, remained 'fair' or better after surgery. In the high-grade group, the postoperative functional statuses were classified as 'no change' or 'aggravated' in all except two patients. No significant difference in the survival rates was detected between patients with and without adjuvant radiotherapy. Conclusions: The tumor grade and the extent of tumor resection were significant prognostic factors for survival rate. In low-grade malignancy group, good motor function was retained when surgeries were performed before substantial neurological deterioration. The efficacy of postoperative radiotherapy has yet to be determined and needs further study.

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Adult intramedullary astrocytomas of the spinal cord

Cited by 225 publications

References 16 publications

Surgical treatment of intramedullary spinal cord tumors: prognosis and complications

Surgical treatment of intramedullary spinal cord tumors: prognosis and complications

Prognostic factors in intramedullary astrocytomas: a literature review

Surgical outcomes of spinal cord astrocytomas

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