Impact of Tumor Histology on Resectability and Neurological Outcome in Primary Intramedullary Spinal Cord Tumors

Karikari, Isaac O.; Nimjee, Shahid M; Hodges, Tiffany R.; Cutrell, Erin; Hughes, Betsy D.; Powers, Ciarán J.; Mehta, Ankit I.; Hardin, Carolyn A; Bagley, Carlos A.; Isaacs, Robert E.; Haglund, Michael M.; Friedman, Allan H.

doi:10.1227/01.neu.0000462073.71915.12

Cited by 49 publications

(12 citation statements)

References 25 publications

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“…Patients presenting with spinal cord astrocytomas span the traditional pediatric and adult age divisions, having an overall age-distribution that is younger than cohorts with supratentorial gliomas. WHO grade I and II astrocytomas have better outcomes that are largely dependent on extent of surgical resection [ 10 ], whereas Grade III and IV astrocytomas are less amenable to safe surgical resection, and typically require adjuvant radiation and chemotherapy for treatment. Given the premium on preserving neurologic function during spinal cord surgery, intraoperative frozen section histologic analysis has an important role in driving therapeutic decision-making.…”

mentioning

confidence: 99%

BRAF alteration status and the histone H3F3A gene K27M mutation segregate spinal cord astrocytoma histology

et al. 2015

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confidence: 99%

BRAF alteration status and the histone H3F3A gene K27M mutation segregate spinal cord astrocytoma histology

et al. 2015

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“…Thirty-nine studies met our inclusion criteria (sample sizes ranged from 10 to 221 patients; the total number of participants across studies was 1191). 7 , 14 - 50 , 56 All the included studies were case series. The description of the studies is presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Complete Versus Incomplete Surgical Resection in Intramedullary Ependymomas: A Systematic Review and Meta-analysis

Salari

Golpayegani

Sadeghi‐Naini

et al. 2020

Global Spine Journal

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Study Design: Systematic review. Objective: To compare outcomes of complete versus incomplete resection in primary intramedullary spinal cord ependymoma. Methods: A comprehensive search of the MEDLINE, CENTRAL, and Embase databases was conducted by 2 independent investigators. Random-effect meta-analysis and meta-regression with seven covariates were performed to evaluate the reason for the heterogeneity among studies. We also used individual patient data in the integrative analysis to compare complete and incomplete resection based on 4 outcomes: progression-free survival (PFS), overall survival (OS), postoperative neurological improvement (PNI), and follow-up neurological improvement (FNI). Results: A total of 23 studies were identified, including 407 cases. Significant heterogeneity among included studies was observed in risk estimates (I2 for PFS, FNI, and PNI were 49.5%, 78.3%, and 87.2%, respectively). The mean follow-up time across cases was 48.6 ± 2.35 months. Cox proportional multivariable analysis revealed that the complete resection can prolong PFS (model, hazard ratio = 0.18, CI 0.05-0.54, P = .004,) and improve the FNI (binary logistic regression, adjusted odds ratio = 16.5, CI 1.6-171, P = .019). However, PNI and OS were similar in patients with incomplete resected spinal cord ependymoma compared with complete resection (binary logistic regression respectively and Cox multivariable analysis, P > .5). Conclusion: The data presented in this study showed that OS was not significantly affected by the degree of surgery. However, complete resection of intramedullary ependymomas provides the optimal outcomes with longer PFS and better long-term neurological outcomes than incomplete resection.

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“…Since ependymomas and hemangioblastomas usually have a clear resection plane, and radical excision is considered curative, surgical resection is usually the treatment of choice for these tumors (13).…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Intra- and Juxtamedullary Spinal Cord Tumors: A Population Based Observational Cohort Study

et al. 2019

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Objective: Intramedullary spinal cord tumors (IMSCT) are rare entities and high-level evidence regarding optimal treatment is lacking. We aim to describe the demographics, histopathological distribution, onset symptoms, treatment strategies, and functional outcome for patients surgically treated for IMSCT. Methods: We performed a retrospective review of a consecutive population-based cohort of 95 patients who underwent surgery for intra- or juxtamedullary tumors at a single institution during the period 2004–2017. Results: When gross total resection (GTR) was achieved, we found no case of local tumor recurrence even in the absence of adjuvant radio- or chemotherapy. Meanwhile, we found a 50% progression rate on long-term MRI follow-up in patients where only a partial resection was possible. At long-term follow-up, there was no significant alteration in functional status, while a significant reduction in share of patients reporting pain, compared to preoperative status, was identified. Poor preoperative functional status and postoperative tumor remnant were identified as individual risk factors for further functional decline. Conclusion: Gross total resection, with minimal post-operative neurological deterioration, is possible in the majority of the cases, especially in the presence of an identifiable resection plane between tumor and healthy spinal cord. Since long-term progression-free survival could be achieved by GTR without additional adjuvant treatment, we emphasize that low-grade tumors should not be subject to radiotherapy. Treatment of high-grade or diffusely infiltrating tumors, tumor remnants, or metastases should be individualized.

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Impact of Tumor Histology on Resectability and Neurological Outcome in Primary Intramedullary Spinal Cord Tumors

Abstract: Tumor histology is the most important predictor of neurological outcome after surgical resection because it predicts resectability and recurrence.

Cited by 49 publications

References 25 publications

BRAF alteration status and the histone H3F3A gene K27M mutation segregate spinal cord astrocytoma histology

BRAF alteration status and the histone H3F3A gene K27M mutation segregate spinal cord astrocytoma histology

Complete Versus Incomplete Surgical Resection in Intramedullary Ependymomas: A Systematic Review and Meta-analysis

Surgical Treatment of Intra- and Juxtamedullary Spinal Cord Tumors: A Population Based Observational Cohort Study

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