Intramedullary Spinal Cord Tumors: Part II—Management Options and Outcomes

Abstract

Study Design Broad narrative review. Objectives Intramedullary spinal cord tumors (IMSCT) are uncommon lesions that can affect any age group or sex. However, numerous IMSCT exist and the clinical course of each tumor varies. The following article addresses the various management options and outcomes in patients with IMSCT. Methods An extensive review of the peer-reviewed literature was performed, addressing management options and clinical outcomes of patients with IMSCT. Results Early diagnosis and intervention are essential to obtain optimal functional outcome. Each IMSCT have specific imaging characteristics, which help in the clinical decision-making and prognostication. A comprehension of the tumor pathology and the clinical course associated with each tumor can allow for the proper surgical and nonsurgical management of these tumors, and reduce any associated morbidity and mortality. Recent advances in the operative management of such lesions have increased the success rate of tumor removal while minimizing iatrogenic-related trauma to the patient and, in tandem, improving patient outcomes. Conclusions Awareness and understanding of IMSCT is imperative to design proper management and obtain optimal patient outcomes. Meticulous operative technique and the use of surgical adjuncts are essential to accomplish proper tumor removal, diminish the risk of recurrence, and preserve neurologic function. Operative management of IMSCT should be individualized and based on tumor type, location, and dimensional extensions. To assist with preoperative and intraoperative decision-making, a general algorithm is provided.

Current surgical strategies for treating spinal tumors: Results of a questionnaire survey among members of the German Spine Society (DWG)

“…Intramedullary(20e30%)/extramedullary(70e80%) primary tumors [25] and the much rarer intradural metastases [26] were treated by a third of the departments in this survey. As expected within the DWG, the treatment situation in view of intradural tumor management seems to be clear-cut, since all intradural tumors are surgically treated in neurosurgical departments.…”

Keyhole approaches to intradural pathologies

“…The aim of our study was to demonstrate a safe and efficient resection technique for intradural pathologies, especially in the light of recent publications focusing on large multilevel laminectomy approaches. 1,24 Extensive approaches have been shown to be closely correlated with postoperative morbidity and deformity, 14,25 especially with postoperative instability. The secondary goal of intramedullary tumor surgery, aside from tumor resection, was correctly defined by Samartzis et al 24 in 2010 to be the preservation of stability in the course of tumor resection if possible.…”

“…1,24 Extensive approaches have been shown to be closely correlated with postoperative morbidity and deformity, 14,25 especially with postoperative instability. The secondary goal of intramedullary tumor surgery, aside from tumor resection, was correctly defined by Samartzis et al 24 in 2010 to be the preservation of stability in the course of tumor resection if possible. The preservation of stability is particularly important in patients with intradural extramedullary tumors.…”

“…To ensure that these requirements were met, extensive approaches were chosen in the past, with laminectomies of 2 or more segments 1,20,24 and large exposure of the tumor area. These approaches led to problems in terms of large wounds with high infection rates and possible bleeding sources 4,17,18,23 and also predisposed patients to spinal instability 4,25 and deformities, 14,15 like the "swan neck" that was observed especially in young patients who underwent multilevel laminectomy.…”

Spontaneous Regression of a Symptomatic Intramedullary Spinal Cord Lesion

“…These tumors can lead to progressive severe neurologic deficits, impaired quality of life, and even death. Early diagnosis and surgical intervention have been quoted as essential to optimizing a patient's functional outcome [3]. However, these are high-risk operations, with 9% to 34% of patients experiencing worsening neurologic deficits following surgery.…”