Primary Spinal Astrocytomas: A Literature Review

Abstract

Primary spinal astrocytoma is a subtype of glioma, the most common spinal cord tumor found in the intradural intramedullary compartment. Spinal astrocytomas account for 6-8% of all spinal cord tumors and are primarily low grade (World Health Organization grade I (WHO I) or WHO II). They are seen in both the adult and pediatric population with the most common presenting symptoms being back pain, sensory dysfunction, or motor dysfunction. Magnetic Resonance Imaging (MRI) with and without gadolinium is the imaging of choice, which usually reveals a hypointense T1 weighted and hyperintense T2 weighted lesion with a heterogeneous pattern of contrast enhancement. Further imaging which may aid in surgical planning includes computerized tomography, diffusion tensor imaging, and tractography. Median survival in spinal cord astrocytomas ranges widely. The factors most significantly associated with poor prognosis and shorter median survival are older age at initial diagnosis, higher grade lesion based on histology, and extent of resection. The mainstay of treatment for primary spinal cord astrocytomas is surgical resection, with the goal of preservation of neurologic function, guided by intraoperative neuromonitoring. Adjunctive radiation has been shown beneficial and may increase overall survival. The role of adjunctive chemotherapy is employed, however, its benefit has not been clearly defined. Primary spinal cord astrocytomas are rare and challenging to treat. The gold standard treatment is surgical resection. Second-line treatments include radiation and chemotherapy, although, the optimal regimen for adjunctive therapy has not yet been clearly defined.

MiR-1225-5p acts as tumor suppressor in glioblastoma via targeting FNDC3B

“…Also, our data revealed that the lower expression of miR-1225-5p indicated the shorter survival time of patients. Recently, it has been found that in primary spinal astrocytoma (a subtype of gliomas), the most significant factors associated with poor prognosis are the lesions with older age and higher histological grade at the initial diagnosis [ 26 ]. On the basis of references and the results of this study, we considered that miR-1225-5p is a biomarker for diagnosis and treatment of glioblastoma.…”

Profil histologique et évolution des tumeurs intra rachidiennes opérées

“…Ainsi aucun patient de notre série n´a bénéficié d´un traitement complémentaire même lorsqu´il y avait une indication (cas du plasmocytome). Plusieurs auteurs [ 10 , 14 , 17 , 18 ] avaient réalisé une chimiothérapie anticancéreuse dans les cas de myélome multiple, de plasmocytome, de sarcome granulocytaire, de neuroblastome. D´autres auteurs [ 10 , 19 ] pratiquaient une radiothérapie dans les cas de plasmocytome solitaire osseux et de neurofibrosarcome primitif.…”

Surgical treatment and neurological outcome of infiltrating intramedullary astrocytoma WHO II–IV: a multicenter retrospective case series

“…The study was a retrospective multicentric analysis conducted in 5 neurosurgical high-volume centers in Germany (3), Austria (1), and Switzerland (1). We analyzed relevant details on the type of surgery performed, the neurosurgical approach, preoperative clinical state (modified McCormick grading), early and long-term postoperative neurological function, tumor size and histopathological results (including the WHO grading of the tumor, molecular markers such as Ki-67, MGMT, and IDH-1 mutation), the EOR (gross total resection [GTR] defined as a complete removal of contrast enhancing tumor, subtotal resection [STR] defined as a removal of more than 90% of the contrast enhancing tumor, tumor debulking, or biopsy), and time to tumor recurrence.…”

“…Due to its rareness, data on adjuvant therapy such as combined chemo-and radiotherapy are sparse [13][14][15], and decisions on a patient's optimal treatment are taken individually without defined guidelines. While most intramedullary astrocytomas of the spinal cord are low-grade tumors (World Health Organization WHO I or II tumors) [1,16], studies on spinal highgrade gliomas are missing. In our study, we therefore analyzed the surgical approach and clinical outcome of patients suffering from infiltrating astrocytomas WHO II, III, and IV in order to better understand the influence of the surgical approach and adjuvant treatment on the overall survival (OS) and tumor recurrence.…”

“…Primary intramedullary spinal cord astrocytomas present rare case entities and account for 30–40% of all spinal cord gliomas [ 1 – 3 ]. Despite technical advances, the outcome of infiltrating astrocytomas remains poor [ 4 – 6 ], and patients suffer from rapid neurological deterioration [ 3 , 5 , 7 ].…”