Comparative analysis on the diagnosis and treatments of multisegment intramedullary spinal cord tumors between the different age groups

Wang, Zhenyu; Sun, Jianjun; Xie, Jingcheng; Li, Zhendong; Ma, Chang-cheng; Liu, Bin; Chen, Xiao; Liao, Hung-I; Tao, Yu; Zhong, Jia

doi:10.1007/s10143-011-0345-2

Cited by 12 publications

(7 citation statements)

References 18 publications

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“…The analysis showed a trend for higher rates of postoperative transient morbidity with increasing age. 20,60 Children tended to recover more quickly compared with more advanced age groups. 60 This can be explained by the loss of spinal cord plasticity and a more vulnerable vascular supply of the cord with growing age.…”

Section: Transient Surgical Morbiditymentioning

confidence: 88%

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

Klekamp

2013

SPI

115

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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: Transient Surgical Morbiditymentioning

confidence: 88%

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

Klekamp

2013

SPI

115

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“…Upright walking therefore underlies the formation of SESMCs. Some authors have attributed cyst formation to the hydrostatic pressure of CSF [1][2]4,[7][8][9][10][11][12][13]. Enlargement of SESMCs may be caused by a ball-valve effect, congenital abnormalities, connective tissue disorders, and nerve root sheath duplications.…”

Section: Discussionmentioning

confidence: 99%

“…It is generally accepted that asymptomatic SESMCs do not require surgical intervention [1][2][3][4][5][7][8][9][10][11][12][13][14][15][16][17][18][19]. When these lesions are symptomatic, the goals of surgical intervention are to relieve nerve stimulation and compression, and stop bone erosion.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of nerve root sheaths for sacral extradural spinal meningeal cysts with spinal nerve root fibers

Sun

Wang

et al. 2013

Sci. China Life Sci.

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This study analyzed the clinical characteristics and outcomes of sacral extradural spinal meningeal cysts with spinal nerve root fibers treated by reconstruction of the nerve root sheaths. The relationships between the cysts and spinal nerve root fibers were examined microscopically, the cysts were partially excised, and the defects were oversewn to reconstruct the nerve root sheaths. The Improved Japanese Orthopedic Association (IJOA) scoring system was used to evaluate preoperative and postoperative neurological function. Thirty-eight patients were included in this study, with a mean age of 41.4±15.57 years. The mean IJOA score was 18.8±1.32 preoperatively and 19.6±0.65 postoperatively, which was a significant difference (t=-3.77, P=0.001). These results indicate a significant improvement in neurological function after surgery. The most significant improvement in neurological function was sensation (z=-2.86, P=0.004), followed by bowel/bladder function (z=-2.31, P=0.02). The pathophysiological mechanism underlying the formation of SESMCs with SNRFs is congenital weakness of the nerve root sheath [3]. High hydrostatic pressure generated by upright walking and a ball-valve effect result in cyst enlargement [3][4][5]. The walls of the cysts are formed by enlargement of the perineural nerve root sheaths, resulting in alteration of the environment around the spinal nerve root fibers. This alteration causes malfunction of the involved spinal nerve root fibers, similar to axonal transport dysfunction [6]. This malfunction differs from malfunction associated with compression against adjacent bone or other nerve

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“…2,3,5,6,16,18,19,27,32 transient morbidity Further analysis showed a trend for higher rates of postoperative transient morbidity with increasing age. 7,11,31 Elderly patients demonstrated more difficulties to overcome deficits of joint position sense in particular. Transient postoperative neurological deteriorations were more common after GTRs than partial resections and after operations by experienced surgeons of Group C, who were more likely to remove a tumor completely.…”

Section: Surgical Morbiditymentioning

confidence: 99%

Spinal ependymomas. Part 1: Intramedullary ependymomas

Klekamp

2015

FOC

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OBJECT Ependymomas represent the most common intramedullary tumor in adults. Despite their usually well-defined dissection plane, surgical morbidity has been documented to be considerably higher compared with other intramedullary entities. This study presents an analysis of risk factors for surgical morbidity and data on long-term results for intramedullary ependymomas. METHODS Among 1447 patients with tumors of the spinal canal treated between 1980 and 2014, 309 patients presented with intramedullary tumors. One hundred patients with intramedullary ependymomas underwent 102 operations. Mean age was 44 ± 15 years (range 8–74 years). Patients were followed by outpatient visits and questionnaires, with a mean follow-up of 77 ± 91 months. Short-term results were determined for individual symptoms and the McCormick Scale, whereas tumor recurrence rates were calculated with Kaplan-Meier statistics. RESULTS Compared with cervical ependymomas, those of the thoracic spine were associated with more severe motor deficits and gait problems at presentation. A total of 86.3% of patients with intramedullary ependymomas underwent gross-total resection (GTR). A low preoperative McCormick grade and first surgery were the strongest predictors for a GTR. Postoperatively, 67.6% of patients demonstrated a worse neurological state at discharge from the hospital. This deterioration was transient for 40.1% of the patients and permanent for 27.5%. In the long term, the McCormick grade remained unchanged from the preoperative grade in 74.5% of patients, while it was improved in 5.9% of patients and increased after surgery in 19.6% of patients. According to a multivariate analysis, the risk of permanent morbidity increased with a thoracic level of the ependymoma, advanced age, a long clinical history, presence of a tumor hemorrhage, and surgery on a recurrent tumor. In the long term, tumor recurrence rates correlated significantly with the amount of resection (4.2% and 18.5% in 20 years after GTR and partial resections, respectively). Postoperative neuropathic pain syndromes affected 37.0% of patients, whereas 4% demonstrated a postoperative myelopathy related to cord tethering at the level of surgery. CONCLUSIONS Intramedullary ependymomas are tumors best treated surgically. A complete resection indicates cure for the overwhelming majority of these patients. Surgery should be performed early by neurosurgeons who deal with these lesions on a regular basis to achieve high GTR rates. Permanent surgical morbidity varies most according to tumor location and patient age.

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Comparative analysis on the diagnosis and treatments of multisegment intramedullary spinal cord tumors between the different age groups

Cited by 12 publications

References 18 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

Reconstruction of nerve root sheaths for sacral extradural spinal meningeal cysts with spinal nerve root fibers

Spinal ependymomas. Part 1: Intramedullary ependymomas

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