Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study

Hirano, Ken‐ichi; Imagama, Shiro; Sato, Koji; Kato, Fumihiko; Yukawa, Yasutsugu; Yoshihara, Hisatake; Kamiya, Mitshuhiro; Deguchi, Masashi; Kanemura, Tokumi; Matsubara, Yumiko; Inoh, Hidefumi; Kawakami, Noriaki; Takatsu, Tetsuro; Ito, Zenya; Wakao, Norimitsu; Ando, Kei; Tauchi, Ryoji; Muramoto, Akio; Matsuyama, Yukihiro; Ishiguro, Naoki

doi:10.1007/s00586-012-2345-5

Cited by 120 publications

(108 citation statements)

References 21 publications

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“…No syrinx developed de novo after pia closure in this series. Table 5 are in line with other series: 1,3,8,20,24,27,40,52,63 ependymomas, astrocytomas, angioblastomas, and cavernomas constitute 86.4% of the total; all other pathologies are rare. Metastases, 21,45 melanocytomas, 18,25 intramedullary neuromas, 5,48 and meningiomas 10,49 are unusual intramedullary lesions mostly discussed as case reports in the literature.…”

Section: Long-term Morbidity-postsurgical Myelopathysupporting

confidence: 88%

Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results

Klekamp

2013

SPI

104

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Object Surgery of intramedullary tumors is established as the treatment of choice for these challenging lesions. This study presents a detailed analysis of risk factors for surgical morbidity and data on long-term results for intramedullary tumors. Methods Among 1317 patients with tumors of the spinal canal treated between 1980 and 2012, 278 patients with intramedullary tumors are presented. A total of 225 of these patients underwent 246 operations for treatment of 250 tumors. The mean patient age was 41 ± 17 years (range 3 weeks to 83 years). Patients underwent follow-up through outpatient visits and questionnaires with a mean follow-up of 41 ± 53 months. Tumors were subdivided into 3 groups: displacing tumors (Type A, n = 162), infiltrating tumors (Type B, n = 80), and nonproliferating tumors (Type C, n = 8). A gross-total resection (GTR) was attempted for every tumor except for Type C lipomas. Participating surgeons were divided into 3 groups according to the number of operations they performed. Short-term results were determined for individual symptoms and the modified McCormick Scale, whereas tumor recurrence rates were calculated with Kaplan-Meier statistics. Results Overall, 83.3% of Type A tumors underwent GTR compared with 22.5% of Type B and none in Type C. Gross-total resection rates increased throughout the study period and correlated significantly with surgical experience. A worsened neurological state after surgery was seen in 61% of patients. This deterioration was transient in 41.5% and was a common observation after GTR. Permanent morbidity (19.5%) was lowest after GTR and correlated significantly with surgical experience and the preoperative neurological state. Further analysis showed that patients with tumors of thoracic levels, tumor hemorrhages, and malignant and recurrent tumors were at a higher risk for permanent morbidity. In the long term, tumor recurrence rates for ependymomas and benign astrocytomas correlated significantly with the amount of resection. Long-term morbidity affected 3.7% with a postoperative myelopathy related to cord tethering at the level of surgery and 21.9% in form of neuropathic pain syndromes. The rate of postsurgical cord tethering could be lowered significantly by using pia sutures after tumor resection. Neuropathic pain syndromes were more common after surgery for tumors with associated syringomyelia or those located in the cervical cord. Conclusions Intramedullary tumors should be surgically treated as soon as neurological symptoms appear. Gross-total resection is possible for the majority of benign pathologies. Cervical tumors are associated with higher GTR and lower permanent morbidity rates compared with thoracic tumors. Surgery on intramedullary tumors should be performed by neurosurgeons who deal with these lesions on a regular basis as considerable experience is required to achieve high GTR rates and to limit rates of permanent morbidity.

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Section: Long-term Morbidity-postsurgical Myelopathysupporting

confidence: 88%

Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results

Klekamp

2013

SPI

104

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“…Male preponderance of 69% and a male/female ratio of 2:7 were observed. 4 Patients clinically present most commonly in the fifth to seventh decade of life with more than 80% being older than 40 years. 5 The midthoracic spine (69%) is the most common site of involvement, followed by the lumbar spine (27%) and the cervical spine (4%).…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

J Neurol Surg Rep

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IntroductionPrimary spinal cord tumors are one of the rarest categories of tumors, representing approximately 4 to 16% of all tumors arising from the central nervous system (CNS). 1 An epidural location for lymphoma is observed in 0.1 to 6.5% of the cases.We describe the diagnostic and management of a 45-yearold man who presented an anterior spinal syndrome secondary to an epidural lesion, which had a histological confirmation of a diffuse large B-cell lymphoma (DLBCL). Case PresentationA 45-year-old man presented with a new onset of highintensity thoracic pain limiting his movements; a month later he was accompanied by decrease in the strength of the left pelvic limb. After 2 months, he started with weakness of both lower limbs and impaired urinary sphincter control.The neurologic examination demonstrated a minor motor impairment of lower limbs and reflexes were hyperactive. He presented a sensory level of hypoesthesia and loss of thermalgesia at T5. Anal sphincter tone was without damage, negative Hoffman, Trömner and Babinski's sign.Magnetic resonance images showed a paravertebral mass hypointense on T1 and T2 with homogeneous enhancement, which produced medullar compression at T3 (►Figs. 1 and 2).The patient was taken into surgery, where we performed a neural decompression by posterior way and biopsy of the extradural spinal lesion. Intraoperatively, we found a fibrotic, gray-colored, vascularized lesion on the right side above the T3-T4 level (►Fig. 3). Keywords► spinal epidural lymphoma ► epidural ► spinal compression AbstractBackground Primary spinal epidural lymphoma (PSEL) is one of the rarest categories of tumors. Spinal cord compression is an uncommon primary manifestation and requires to be treated with surgery for the purpose of diagnosis and decompression. Case Presentation A 45-year-old man presented with a new onset thoracic pain and progress to an anterior spinal syndrome with hypoesthesia and loss of thermalgesia. Magnetic resonance image showed a paravertebral mass that produces medullary compression at T3. The patient was taken up to surgery, where the pathology examination showed a diffuse large B-cell lymphoma. Conclusions PSEL is a pathological entity, which must be considered on a middle-aged man who began with radicular compression, and the treatment of choice is decompression and biopsy. The specific management has not been established yet, but the literature suggests chemotherapy and radiotherapy; however, the outcome is unclear.

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“…The clinical and radiological features of Case 1 included that the patient initially showed myelopathy caused by an isolated intramedullary spinal cord lesion. The incidence of intramedullary lymphoma is exceedingly rare (6,7,9). Furthermore, isolated spinal cord involvement is uncommon and observed in <1% of cases of PCNSL (3).…”

Section: Discussionmentioning

confidence: 99%

Lymphomatosis Cerebri with Intramedullary Spinal Cord Involvement

et al. 2013

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Lymphomatosis cerebri (LC) is a rare form of primary central nervous system lymphoma (PCNSL). Little is known about cases of LC with spinal cord involvement. Among the 11 PCNSL patients treated in our hospital during a four-year period, we identified two cases of LC with spinal cord lesions. One showed a spinal cord lesion followed by leukoencephalopathy. The other showed a spinal cord lesion after LC. In both cases, the histopathology was diffuse large B-cell lymphoma. It is possible that LC may affect the entire central nerve system, and tumor infiltration to the brain and spinal cord in LC may occur more frequently than has been previously considered.

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Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study

Cited by 120 publications

References 21 publications

Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results

Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results

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Lymphomatosis Cerebri with Intramedullary Spinal Cord Involvement

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