Recurrent spinal cord astrocytoma with intraventricular seeding

Peraud, Aurelia; Herms, Jochen; Schlegel, Jürgen; Müller, Peter E.; Kretzschmar, Hans; Tonn, Joerg‐Christian

doi:10.1007/s00381-003-0812-3

Cited by 16 publications

(21 citation statements)

References 10 publications

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“…The associ ation between hydrocephalus and intramedullary tumors has been well described, both as a presenting symptom and as a manifestation of disease progression. 37,49 Obstruction of CFS occurs through leptomeningeal disease in patients with high-grade tumors and secondary to altered CSF viscosity and tumor hemorrhage. 34,39 Rostral extension of syringomyelia to the cervicomedullary junction can also cause hydrocephalus by mechanical obstruction of CSF outlet pathways in low-grade intramedullary tumors.…”

Section: Hydrocephalus and Syringomyeliamentioning

confidence: 99%

Long-term disease and neurological outcomes in patients with pediatric intramedullary spinal cord tumors

Ahmed¹,

Menezes²,

Awe³

et al. 2014

PED

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Object Radical resection is recommended as the first-line treatment for pediatric intramedullary spinal cord tumors (IMSCTs), but it is associated with morbidity, including risk of neurological decline and development of postoperative spinal deformity. The authors report long-term data on clinical and treatment determinants affecting disease survival and neurological outcomes. Methods Case records for pediatric patients (< 21 years of age at presentation) who underwent surgery for IMSCTs at the authors' institution between January 1975 and January 2010 were analyzed. The patients' demographic and clinical characteristics (including baseline neurological condition), the treatment they received, and their disease course were reviewed. Long-term disease survival and functional outcome measures were analyzed. Results A total of 55 patients (30 male and 25 female) were identified. The mean duration of follow-up (± SEM) was 11.4 ± 1.3 years (median 9.3 years, range 0.2–37.2 years). Astrocytomas were the most common tumor subtype (29 tumors [53%]). Gross-total resection (GTR) was achieved in 21 (38%) of the 55 patients. At the most recent follow-up, 30 patients (55%) showed neurological improvement, 17 (31%) showed neurological decline, and 8 (15%) remained neurologically stable. Patients presenting with McCormick Grade I were more likely to show functional improvement by final follow-up (p = 0.01) than patients who presented with Grades II–V. Kaplan-Meier actuarial tumor progression-free survival rates at 5, 10, and 20 years were 61%, 54%, and 44%, respectively; the overall survival rates were 85% at 5 years, 74% at 10 years, and 64% at 20 years. On multivariate analysis, GTR (p = 0.04) and tumor histological grade (p = 0.02) were predictive of long-term survival; GTR was also associated with improved 5-year progression-free survival (p = 0.01). Conclusions The prognosis for pediatric IMSCTs is favorable with sustained functional improvement expected in a significant proportion of patients on long-term follow-up. Long-term survival at 10 years (75%) and 20 years (64%) is associated with aggressive resection. Gross-total resection was also associated with improved 5-year progression-free survival (86%). Hence, the treatment benefits of GTR are sustained on extended follow-up.

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Section: Hydrocephalus and Syringomyeliamentioning

confidence: 99%

Long-term disease and neurological outcomes in patients with pediatric intramedullary spinal cord tumors

Ahmed¹,

Menezes²,

Awe³

et al. 2014

PED

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“…Dissemination of tumor cells has been reported in virtually all types of primary central nervous system neoplasms. Spinal spread of primary intracranial tumors is not unusual, and autopsy series have found such spread in anywhere from 20 to 36% of supratentorial tumors and up to 60% of infratentorial lesions 19) . This phenomenon is predominantly observed in malignant tumors, especially medulloblastomas, germ cell tumors, and high-grade gliomas.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Cerebral metastases of a primary spinal astrocytoma have rarely been reported 1,6,13,17,19,22,24,25) . Of the spinal cord gliomas reported to have metastasized to the brain, most were anaplastic astrocytomas or glioblastoma multiforme 7,13,19,20,24,25) . Seeding to cranial sites from intramedullary low-grade astrocytoma has been reported in only a few cases; these have reported intracranial spread of intramedullary pilocytic astrocytoma without malignant transformation in a child 1,17) and with malignant transformation in an adult 6,19,24) .…”

Section: Introductionmentioning

confidence: 99%

“…Of the spinal cord gliomas reported to have metastasized to the brain, most were anaplastic astrocytomas or glioblastoma multiforme 7,13,19,20,24,25) . Seeding to cranial sites from intramedullary low-grade astrocytoma has been reported in only a few cases; these have reported intracranial spread of intramedullary pilocytic astrocytoma without malignant transformation in a child 1,17) and with malignant transformation in an adult 6,19,24) . We report the case of a metastatic spread to the cerebellum of a low-grade astrocytoma without malignant transformation in a 52 year-old male.…”

Section: Introductionmentioning

confidence: 99%

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Intracranial Metastases of Cervical Intramedullary Low-Grade Astrocytoma without Malignant Transformation in Adult

Jang

Kong

Song

et al. 2009

J Korean Neurosurg Soc

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The first case of intracranial metastases of a cervical intramedullary low-grade astrocytoma without malignant transformation in adult is presented in this report. Seven years ago, a 45 year-old male patient underwent biopsy to confirm pathologic characteristics and received craniocervical radiation and chemotherapy for a grade II astrocytoma in the cervical spinal cord. Two years later, posterior fusion was necessary for progressive kyphosis in the cervical spine. He was well for approximately 7 years after the primary surgery. Two months ago, he presented with partial weakness and incoordination with gait difficulty. MRI Scan demonstrated multiple small lesions in the cerebellar vermis and left hemisphere. After suboccipital craniectomy and posterior cervical exposure, the small masses in the cerebellar vermis and hemispheres were excised to a large extent by guidance of an intraoperative navigation system. The tumor at the cervical and brain lesions was classified as an astrocytoma (WHO grade II). When a patient with low-grade astrocytoma in the spinal cord has new cranial symptoms after surgery, radiaton, and chemotherapy, the possibility of its metastasis should be suspected because it can spread to the intracranial cavity even without malignant transformation as shown in this case.

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Metastatic Low‐Grade Gliomas in Children: 20 Years' Experience at St. Jude Children's Research Hospital

Chamdine

Broniscer

et al. 2015

Pediatric Blood & Cancer

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Background Patients with low-grade gliomas (LGG), which are the most common childhood brain tumors, have excellent long-term survival. Dissemination of LGG is rare. Robust data on the incidence, presentation, patterns of dissemination, disease behavior, outcome, and best-management approaches do not exist. We describe 20 years of follow-up of children with metastatic LGG. Procedure Data collected during the period 1990–2010 were retrospectively reviewed for the following inclusion criteria: diagnosis of metastatic LGG, age younger than 21 years at initial diagnosis, and magnetic resonance imaging of the brain and/or spine at diagnosis and/or follow-up. Patient demographics, pathology, treatment modalities, and outcome were reviewed. Results Of 599 patients with LGG, 38 (6%) had metastatic disease at either diagnosis or follow-up. Most tumors (87%) were located in the brain, and half of the patients had metastatic disease at presentation. The most common diagnosis was pilocytic astrocytoma (55%). Chemotherapy was the most common initial treatment modality. Median survival of the group was 6.2 years (range, 0.1–16.9 years). Fifteen (40%) patients died at a median of 6 years from diagnosis (range, 0.8–15 years). Overall survival at 5, 10, and 15 years was 80.7 ± 6.6%, 63.0 ± 10.2%, and 50.9 ±16.0%, respectively. Conclusion This study describes the longest follow-up of children with metastatic LGG. LGG is underestimated and entails major morbidity and mortality. Prospective studies are needed to learn the true incidence, study the biology, and determine the best approaches to diagnosis, treatment, and follow-up.

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Recurrent spinal cord astrocytoma with intraventricular seeding

Cited by 16 publications

References 10 publications

Long-term disease and neurological outcomes in patients with pediatric intramedullary spinal cord tumors

Long-term disease and neurological outcomes in patients with pediatric intramedullary spinal cord tumors

Intracranial Metastases of Cervical Intramedullary Low-Grade Astrocytoma without Malignant Transformation in Adult

Metastatic Low‐Grade Gliomas in Children: 20 Years' Experience at St. Jude Children's Research Hospital

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