High-grade intramedullary astrocytomas: 30 years' experience at the Neurosurgery Department of the University of Rome “Sapienza”

Abstract

<jats:sec><jats:title>Object</jats:title><jats:p>The goal in this study was to review a series of patients who underwent surgical removal of intramedullary high-grade gliomas, focusing on the functional outcome, recurrence rates, and technical problems continually debated in neurosurgical practice.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Between December 1976 and December 2006, 22 patients underwent removal of intramedullary high-grade gliomas. Lesions were located in the cervical spinal cord in 12 patients, and in the thoracic cord in 10.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>. Histological examinations showed 10 Grade III astrocytomas and 12 glioblastomas. Only 2 of the 22 high-grade astrocytomas could be completely removed. The clinical postoperative status worsened in 14 patients (63.6%), was unchanged in 7 patients (31.8%), and there was 1 case of intraoperative death (4.5%). None of the 22 patients showed improvement in their neurological status postoperatively. In this series, excluding the 1 intraoperative death, all patients died of progression of the malignancy.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Surgical treatment did not ameliorate the postoperative neurological status; instead, in the majority of cases, it prompted a worsening of the deficit. Radiotherapy and chemotherapy have a little influence on the length of survival. In this series, multimodality treatment of intramedullary high-grade astrocytomas has been shown to increase length of survival without improving the neurological status.</jats:p></jats:sec>

Pediatric spinal glioblastoma multiforme: current treatment strategies and possible predictors of survival

“…It has been observed that tumors located in the thoracic region may have a more favorable prognosis than those in the cervical region [7]. This is likely due to the increased morbidity associated with tumor invasion into the high cervical spinal cord, as well as cervical instability that may result from the resection of these tumors [7].…”

“…It has been observed that tumors located in the thoracic region may have a more favorable prognosis than those in the cervical region [7]. This is likely due to the increased morbidity associated with tumor invasion into the high cervical spinal cord, as well as cervical instability that may result from the resection of these tumors [7]. Although the numbers were too low to establish statistical significance, patients with tumors in the cervical region survived an average of 12.5 months, those with thoracic tumors, an average of 18.7 months, and the one with a cervicothoracic tumor, 11.5 months.…”

Cordectomy for intramedullary spinal cord glioblastoma with a 12-year survival

“…Of these, spinal cord glioblastoma multiforme (GBM) is rare, representing approximately 7.5% of all spinal cord gliomas. [46121418202223] Treatment for spinal gliomas typically includes surgery with postoperative radiation and chemotherapy. In cases of spinal GBM, however, the prognosis is poor, with an average survival of 18 months.…”

Neurosurgical Management of Gliomas

“…Mean survival is quoted at 6 -19 months for grade III and IV spinal cord gliomas. Therefore these tumours are probably just as lethal as their brain counterparts (Cohen et al, 1989;McGirt et al, 2008;Raco et al, 2010). Treatment is the same with debulking, radiotherapy and temozolomide, but often an extensive debulking as with brain GBM is not possible, and the maximum amount of targeted radiotherapy is also less than with brain GBM.…”