Surgical Management of Intramedullary Spinal Cord Tumors

Abstract

We are reporting the functional outcome of 69 of 86 patients affected by intramedullary spinal cord tumors who underwent surgery at our department during the period of 1984 to 1992. The results on 17 patients affected by hemangioblastomas and cavernomas were excluded from this study and will be published separately. Twenty-eight patients had astrocytic processes; 34 had ependymoma; 4 had lipoma; 2 had neurofibroma; and 1 had oligodendroglioma. The overall rate of "radically" resected tumors was 55.1%, as opposed to 17.4% "quasiradically," and 27.5% of "partially" resected processes. There was one postoperative death. Five other patients, affected by anaplastic astrocytomas, died because of tumor progress within 16 months from the operation. A postoperative functional assessment showed that the function of the upper and lower extremities had deteriorated in 65.4 and 55.1% of the patients; a respective functional deterioration by 1 degree of the scale of Cooper and Epstein was registered in 88.8 and 86.8% of the patients. The patients who recovered improved within a period of 6 to 18 months, whereas the function of the dorsal columns was impaired the longest. At follow-up (mean, 54 mo; range, 8-107 mo), the functional recovery (as compared with the preoperative status) was as follows: upper extremity, 17.1% of the patients were improved, 55.5% were unchanged, and 31.5% were worse (89.4% by 1 degree); lower extremity, 22.4% of the patients were improved, 51.5% were unchanged, and 29.4% were worse (most by 1 degree). Surgery on tumors of the cervicothoracic and upper thoracic region carried a relatively higher morbidity in this series.(ABSTRACT TRUNCATED AT 250 WORDS)

Outcome predictors and complications in the management of intradural spinal tumours

“…It is now widely accepted that aggressive surgical excision is the primary treatment for intramedullary tumours to control disease and prevent neurological decline [5][6][7]23]. [21,22] and the extent of excision has been shown to be statistically significant in determining disease recurrence in ependymomas [3], though this is not borne out in our study.…”

Prognostic factors in intramedullary astrocytomas: a literature review

“…Further safety from intraoperative neurological injury is brought by the addition of neurophysiological monitoring into the surgical armamentarium [39,75]. More extensive resection was not associated with neurological decline after surgery [9,11,34,46] (Table 17), preoperative neurological function was the most important parameter for favorable functional outcome [6, 8, 9, 11, 13-15, 26, 41, 51, 52, 57, 62]. Another problem encountered with surgery is the assessment of EOR and definition of GTR.…”

“…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).…”

Surgical treatment of intramedullary spinal cord tumors: prognosis and complications

“…5,6 Ependymomas can usually be resected completely under a microscope; however, the rate of total resection in past reports has been approximately 70%. 5,6 In recent years, 4,7,8 however, the rate has improved to approximately 90%, as in the present report. These higher percentages appear to be attributable to advances in diagnostic imaging and improvements in the surgical techniques in recent years.…”