Spinal intradural tumours: Part II-intramedullary

KANE, P. J.; El-Mahdy, Wael; Singh, Anahat; Powell, Michael; Crockard, H A

doi:10.1080/02688699943051

Cited by 88 publications

(59 citation statements)

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“…The meningioma recurrence was 5.5% in our study with a mean time to recurrence of 3 years and 1 month, which is comparable to other published studies [25]. Unsurprisingly, the majority of complications were due to dural CSF leak and meningitis, the incidence of which ranges from 5-13% and 1-10%, respectively [5,8,9,21,23]. Watertight dural closure is not always possible, especially with extramedullary meningiomas when the dura may be resected as part of the attempt to achieve complete excision.…”

Section: Discussionsupporting

confidence: 85%

“…Some authors advise an aggressive surgical approach [8,9,17,20] but we adopt a different stance with the minimum bone removal to maintain spinal column stability and avoid the need for instrumentation, which makes post-operative MRI interpretation difficult. Only three patients deteriorated post-operatively, two remained ambulant, and one patient, who initially improved, developed MRSA meningitis leading to paralysis.…”

Section: Discussionmentioning

confidence: 99%

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Outcome predictors and complications in the management of intradural spinal tumours

et al. 2005

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Outcome predictors and complications in the management of intradural spinal tumours

et al. 2005

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“…2,9,22,26,32,33,36,44,46 The overall rate of tumor progression in our series was 47%, with a mean onset of 3 years postoperatively (mean [± SEM] 3.3 ± 1 years, range 0.1-20 years). Radiotherapy was used following disease progression or recurrence in 51% of the 55 patients, while chemotherapy was used in 29% of the patients.…”

Section: Role Of Adjunct Therapymentioning

confidence: 73%

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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“…In 1999 Kane et al 13 reported that the gait status was aggravated and unchanged in 6 (12%) and 45 (82%) of 54 patients with intramedullary tumors. In 1994 Cristante and Herrmann 5 reported that the outcome was aggravated, unchanged, and improved in 31, 55, and 17% of 69 intramedullary tumor cases, respectively.…”

Section: Discussionmentioning

confidence: 99%

Surgical results of intramedullary spinal cord tumor with spinal cord monitoring to guide extent of resection

Matsuyama¹,

Sakai²,

Katayama³

et al. 2009

SPI

125

108

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Object The authors investigated the outcome of intramedullary spinal cord tumor surgery, focusing on the effect of preoperative neurological status on postoperative mobility and the extent of tumor excision guided by intraoperative spinal cord monitoring prospectively. Methods Intramedullary spinal cord tumor surgery was performed in 131 patients between 1997 and 2007. The authors compared the pre- and postoperative neurological status and examined the type of surgery in 106 of these patients. A modified McCormick Scale (Grades I–V) was used to assess ambulatory ability (I = normal ambulation; II = mild motor sensory deficit, independent without external aid; III = independent with external aid; IV = care required; and V = wheelchair required). The type of surgery was classified into 4 levels: total resection, subtotal resection, partial resection, and biopsy. Results The 106 patients consisted of 47 females and 59 males, whose average age was 42.5 years (range 6–75 years). The mean follow-up period was 7.3 years (range 2.5 months–21 years). The tumor types included astrocytoma (12 cases), ependymoma (46 cases), hemangioblastoma (16 cases), cavernous hemangioma (17 cases), and others (15 cases overall: gangliocytoma, 1; germ cell tumor, 1; lymphoma, 3; neurinoma, 1; meningioma, 1; oligodendroglioma, 1; sarcoidosis, 2; glioma, 1; and unknown, 4). Initial total excision, subtotal resection, partial resection, biopsy, and duraplasty were performed in 59, 12, 22, 12, and 1 patients, respectively. According to the preoperative McCormick Scale, ambulatory status was classified as Grades I, II, III, IV, and V in 41(38%), 30 (28%), 14 (13%), 19 (19%), and 2 (2%) patients, respectively. Thirty-three (31%) of 106 patients suffered postoperative neurological deterioration. The number of patients who did not lose ambulatory ability or who achieved an ambulatory status of Grade I or II postoperatively was 33 (80%), 21 (70%), 10 (71%), 8 (42%), and 1 (50%) in patients with preoperative Grades I, II, III, IV, and V, respectively. Total excision was performed in 31 (79%) of 39 patients with preoperative Grade I, 12 (40%) of 30 patients with Grade II, 7 (50%) of 14 patients with Grade III, and 9 of 21 patients (38%) with Grade IV or V, indicating that the rate of total excision was significantly higher in patients with Grade I status. Conclusions The postoperative ambulatory ability was excellent in patients with a good preoperative neurological status. Total excision in patients with Grade I or II ambulation was associated with a good prognosis for postoperative mobility. However, the rate of postoperative deterioration was 31.5%, which is relatively high, and patients should be fully informed of this concern prior to intramedullary spinal cord tumor surgery.

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Spinal intradural tumours: Part II-intramedullary

Cited by 88 publications

References 0 publications

Outcome predictors and complications in the management of intradural spinal tumours

Outcome predictors and complications in the management of intradural spinal tumours

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

Surgical results of intramedullary spinal cord tumor with spinal cord monitoring to guide extent of resection

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