Current Trends in the Surgical Management of Intramedullary Tumors: A Multicenter Study of 1,033 Patients by the Neurospinal Society of Japan

Abstract

Objective: We performed a retrospective observational study to demonstrate the surgical risks and long-term prognoses of intramedullary tumors in Japan using a multicenter registry authorized by the Neurospinal Society of Japan.Methods: Data from 1,033 consecutive patients with intramedullary tumors, treated between 2009 and 2020, were collected from 58 centers. Patients with spinal lipomas or myxopapillary ependymomas were excluded. Patient characteristics, clinical presentations, imaging characteristics, treatments, and outcomes were analyzed. The modified McCormick scale was used to classify functional status. Survival was described using Kaplan-Meier curves, and multivariable logistic regression analyses were performed.Results: The mean age of the patients was 48.4 years. Data of 361 ependymomas, 196 hemangioblastomas, 168 astrocytic tumors, 160 cavernous malformations, and the remaining 126 cases including subependymomas, metastases, schwannomas, capillary hemangiomas, and intravascular B-cell lymphomas were analyzed. Twenty-two patients were undiagnosed. The mean follow-up duration was 46.1 ± 38.5 months. Gross total tumor removal was achieved in 672 tumors (65.1%). On the modified McCormick scale, 234 patients (22.7%) had worse postoperative grades at the time of discharge. However, neurological status gradually improved. At 6 months postoperatively, 251 (27.5%), 500 (54.9%), and 160 patients (17.6%) had improved, unchanged, and worsened grades, respectively. Preoperative functional status, gross total tumor removal, and histopathological type were significantly associated with mortality and functional outcomes.Conclusion: Our findings demonstrate better postoperative functional outcomes in patients with fewer preoperative neurological deficits. Degree of resection, postoperative treatments, and prognoses are closely related to the histology of intramedullary tumors.

First Clinical Report of the Intraoperative Macro- and Micro-Photodiagnosis and Photodynamic Therapy Using Talaporfin Sodium for a Patient with Disseminated Lumbar Medulloblastoma

“…Owing to these reasons, it is possible that PDT has not been recognized as a treatment option by physicians who usually treat malignant the spinal cord tumors. In fact, according to a recent report from Japan of 1033 cases of intramedullary spinal cord tumors in the previous 12 years [ 12 ], there were only 29 cases (2.8%) of tumors demonstrating a malignant histology including WHO grades 3 or 4. Furthermore, in a study of 48 cases during 7 years from France [ 13 ], there were only 3 cases (6.3%) of tumors demonstrating malignant histology.…”

“…Furthermore, in a study of 48 cases during 7 years from France [ 13 ], there were only 3 cases (6.3%) of tumors demonstrating malignant histology. Among Japanese cases, after surgery, the adjuvant radiotherapy was performed on 130 patients (12.6%) including those with grade 2 ependymomas, and temozolomide-based chemotherapy was performed on 81 patients (7.8%) [ 12 ], however, no other types of treatment were performed in this previous Japanese study [ 12 ].…”

Description of the Diversity in Surgical Indication and Surgical Strategies for Primary Spinal Cord Tumors: A Nationwide Survey by the Neurospinal Society of Japan

“…2 Approximately 70% of PSCTs are reported to be benign or unknown, 3 suggesting that most PSCTs can be cured by total resection. 4 Postoperative worsening of neurological symptoms is not common in PSCTs, which has been reported to be 2.2%. 5 However, the removal of PSCTs, especially intramedullary tumors that originate in the spinal cord, inevitably involves invasion of normal nerve tissues, and the procedure requires a sensitive technique based on extensive experience.…”

“…PSCTs arise from the meninges, spinal cord, and cauda equina, with annual incidence of 0.35, 0.59, and 0.03 per 100,000 persons, respectively [ 2 ]. Approximately 70% of PSCTs are reported to be benign or unknown [ 3 ], suggesting that most PSCTs can be cured by total resection [ 4 ].…”

Clinical Characteristics and Treatment Outcomes of Long-Level Intramedullary Spinal Cord Tumors: A Consecutive Series of 43 Cases

“…In this study, we reported our experience with LIMSCTs, which has rarely been discussed separately in previous literature. 8,9 Based on a series of 43 patients treated in our institution, we analyzed the tumor characteristics, extent of resection and clinical outcomes and attempted to provide answers on optimal treatment strategies for LIMSCTs.…”