Surgical management of long intramedullary spinal cord tumors

Tobias, Michael; McGirt, Matthew J.; Chaichana, Kaisorn L.; Goldstein, Ira M.; Kothbauer, Karl F.; Epstein, Fred J.; Jallo, George I.

doi:10.1007/s00381-007-0405-7

Cited by 48 publications

(44 citation statements)

References 14 publications

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“…3,11,13,24 A series of publications have already reported good outcomes (using the mMS) and determined the safety and efficacy of the best possible microsurgical tumor removal with the aid of intraoperative neurophysiological monitoring. 1,2,[5][6][7][8]12,14,17,18,21,25 No significant overall impact on reported QOL can be measured using the PedsQL 4.0 when comparing children with IMSCT and a healthy collective. There is only one minor exception to this conclusion: in the physical health item of the CSR score in the low-grade subgroup (Fig.…”

Section: Discussionmentioning

confidence: 99%

Quality of life after surgical treatment of primary intramedullary spinal cord tumors in children

Schneider¹,

Hidalgo²,

Schmitt‐Mechelke

et al. 2014

PED

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Object Presently, the best available treatment for intramedullary spinal cord tumors (IMSCTs) in children is microsurgery with the objective of maximal tumor removal and minimal neurological morbidity. The latter has become manageable with the development and standard use of intraoperative neurophysiological monitoring. Traditionally, the perioperative neurological evaluation is based on surgical or spinal cord injury scores focusing on sensorimotor function. Little is known about the quality of life after such operations; therefore, this study was designed to investigate the impact of surgery for IMSCTs on the quality of life in children. Methods Twelve consecutive pediatric patients treated for IMSCT were included in this retrospective fixed cohort study. A multidimensional questionnaire-based quality of life instrument, the Pediatric Quality of Life Questionnaire version 4 (PedsQL 4.0), was chosen to analyze follow-up data. This validated instrument particularly allows for a comparison between a patient cohort and a healthy pediatric sample population. Results Of 11 mailed questionnaires (1 patient had died of progressive disease), 10 were returned, resulting in a response rate of 91%. There were 8 low-grade lesions (5 pilocytic astrocytomas, 1 ganglioglioma, 1 hemangioblastoma, and 1 cavernoma) and 4 high-grade lesions (2 anaplastic gangliogliomas, 1 glioblastoma, and 1 glioneuronal tumor). The mean age at diagnosis was 7.5 years, the mean follow-up was 4.2 years, and 83% of the patients were male. Total resection was achieved in 5 patients and subtotal resection in 7. Four patients had undergone 2 or more resections. The 4 patients with high-grade tumors and 2 with incompletely resected low-grade tumors underwent adjuvant treatment (2 chemotherapy and 4 both radiotherapy and chemotherapy). The mean modified McCormick Scale score at the time of diagnosis was 1.7; at the time of follow-up, 1.5. The mean PedsQL 4.0 total score in the low-grade group was 78.5; in the high-grade group, 82.6. There was no significant difference in PedsQL 4.0 scores between the patient cohort and the normal population. Conclusions In a small cohort of children who had undergone surgery for IMSCTs with a mean follow-up of 4.2 years, quality of life scores according to the PedsQL 4.0 instrument were not different from those in a normal sample population.

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Section: Discussionmentioning

confidence: 99%

Quality of life after surgical treatment of primary intramedullary spinal cord tumors in children

Schneider¹,

Hidalgo²,

Schmitt‐Mechelke

et al. 2014

PED

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“…Significantly, longitudinal tumor span was not associated with adverse survival outcomes, indicating that even extensive multisegment intramedullary tumors can be resected with minimal adverse impact on disease survival, consistent with earlier reports. 10,12,47 …”

Section: Additional Factors Associated With Os and Pfsmentioning

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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“…2 In the United States, an estimated 850-1700 new primary SCT cases are diagnosed each year. Contrary to their intracranial counterparts, primary SCTs are 10-15 times less frequent 68 and do not exhibit an association between increasing malignancy grade and age at the time of presentation. 2,16 Based on their anatomical location with respect to the dura, these tumors are broadly classified as being extradural or intradural.…”

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confidence: 84%

“…Although resection is considered safe and effective, 21,26,34,46,55,59,60 postoperative complications vary based on patient comorbidities, tumor location, size, and extent, as well as hospital-and surgeon-related risk factors. Several singleinstitution studies 14,27,49,52,[68][69][70][71][72] have investigated long-term outcomes and associations of various preoperative risk factors with outcomes in patients undergoing resection for intradural spine tumors. Most of these retrospective analyses, however, are limited in the generalizability of their conclusions given their inherent selection bias.…”

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confidence: 99%

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

Kalakoti

Missios

Menger

et al. 2015

FOC

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OBJECT Because of the limited data available regarding the associations between risk factors and the effect of hospital case volume on outcomes after resection of intradural spine tumors, the authors attempted to identify these associations by using a large population-based database. METHODS Using the National Inpatient Sample database, the authors performed a retrospective cohort study that involved patients who underwent surgery for an intradural spinal tumor between 2002 and 2011. Using national estimates, they identified associations of patient demographics, medical comorbidities, and hospital characteristics with inpatient postoperative outcomes. In addition, the effect of hospital volume on unfavorable outcomes was investigated. Hospitals that performed fewer than 14 resections in adult patients with an intradural spine tumor between 2002 and 2011 were labeled as low-volume centers, whereas those that performed 14 or more operations in that period were classified as high-volume centers (HVCs). These cutoffs were based on the median number of resections performed by hospitals registered in the National Inpatient Sample during the study period. RESULTS Overall, 18,297 patients across 774 hospitals in the United States underwent surgery for an intradural spine tumor. The mean age of the cohort was 56.53 ± 16.28 years, and 63% were female. The inpatient postoperative risks included mortality (0.3%), discharge to rehabilitation (28.8%), prolonged length of stay (> 75th percentile) (20.0%), high-end hospital charges (> 75th percentile) (24.9%), wound complications (1.2%), cardiac complications (0.6%), deep vein thrombosis (1.4%), pulmonary embolism (2.1%), and neurological complications, including durai tears (2.4%). Undergoing surgery at an HVC was significantly associated with a decreased chance of inpatient mortality (OR 0.39; 95% CI 0.16−0.98), unfavorable discharge (OR 0.86; 95% CI 0.76−0.98), prolonged length of stay (OR 0.69; 95% CI 0.62−0.77), high-end hospital charges (OR 0.67; 95% CI 0.60−0.74), neurological complications (OR 0.34; 95% CI 0.26−0.44), deep vein thrombosis (OR 0.65; 95% CI 0.45−0.94), wound complications (OR 0.59; 95% CI 0.41−0.86), and gastrointestinal complications (OR 0.65; 95% CI 0.46−0.92). CONCLUSIONS The results of this study provide individualized estimates of the risks of postoperative complications based on patient demographics and comorbidities and hospital characteristics and shows a decreased risk for most unfavorable outcomes for those who underwent surgery at an HVC. These findings could be used as a tool for risk stratification, directing presurgical evaluation, assisting with surgical decision making, and strengthening referral systems for complex cases.

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Surgical management of long intramedullary spinal cord tumors

Cited by 48 publications

References 14 publications

Quality of life after surgical treatment of primary intramedullary spinal cord tumors in children

Quality of life after surgical treatment of primary intramedullary spinal cord tumors in children

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

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

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