Contemporary management of adult intramedullary spinal tumors—pathology and neurological outcomes related to surgical resection

Manzano, Glen; Green, B A; Vanni, Steven; Levi, Allan D.

doi:10.1038/sc.2008.51

Cited by 115 publications

(83 citation statements)

References 14 publications

(13 reference statements)

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“…This immediate postoperative worsening involved sensory functions for almost all patients, 19,38,39,57 but could also affect motor power, walking abilities or sphincter control. Apart from postoperative sensory dysfunctions, 61% of the patients in this series experienced a postoperative worsening of motor functions, gait, or sphincter control.…”

Section: Postoperative Morbiditymentioning

confidence: 99%

“…In the anatomical midline, small vessels can be followed from either side as they converge into the cord along this septum. 39,57 Dorsal column mapping may also be used to define this midline and was associated with reduced postoperative morbidity for sensory functions in a recent report. 43 Once the spinal cord has been opened over the entire extension of the tumor, pial retention sutures should be used to minimize further surgical manipulations of sensory tracts during tumor removal.…”

Section: Postoperative Sensory Dysfunctionsmentioning

confidence: 99%

“…Whenever the spinal cord had covered the intramedullary tumor completely, sensory functions suffered permanently to some degree. 34,39 Apart from impaired sensations for light touch, temperature, and pain, which may render patients vulnerable to unnoticed injuries, specific problems related to impaired joint position sense may arise for elderly patients in particular.…”

Section: Postoperative Sensory Dysfunctionsmentioning

confidence: 99%

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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: Postoperative Morbiditymentioning

confidence: 99%

Section: Postoperative Sensory Dysfunctionsmentioning

confidence: 99%

Section: Postoperative Sensory Dysfunctionsmentioning

confidence: 99%

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

Klekamp

2013

SPI

115

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“…This immediate postoperative worsening involved sensory functions for almost all patients. 6,19,21,29 Postoperative sensory deficits are an inevitable consequence of the myelotomy required to reach an intramedullary tumor. 16,21 The length of the myelotomy was found to correlate with postoperative sensory dysfunctions in several studies.…”

Section: Surgical Morbiditymentioning

confidence: 99%

“…6,19,21,29 Postoperative sensory deficits are an inevitable consequence of the myelotomy required to reach an intramedullary tumor. 16,21 The length of the myelotomy was found to correlate with postoperative sensory dysfunctions in several studies. 4,5,19,30 The only tumors which could be removed without inflicting such sensory disturbances were those that had reached the pia mater or grown out of the cord in exophytic fashion.…”

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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TENS and FES for sensory impairment and gait dysfunction following removal of spinal cord ependymoma — a case report

Donnellan

Caldwell

2009

Physiotherapy Res Intl

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Contemporary management of adult intramedullary spinal tumors—pathology and neurological outcomes related to surgical resection

Cited by 115 publications

References 14 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

Spinal ependymomas. Part 1: Intramedullary ependymomas

TENS and FES for sensory impairment and gait dysfunction following removal of spinal cord ependymoma — a case report

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