Spinal Cord Astrocytomas: Presentation, Management, and Outcome

Roonprapunt, Chan; Houten, John K.

doi:10.1016/j.nec.2005.10.006

Cited by 37 publications

(25 citation statements)

References 34 publications

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“…In previous studies, histologic grade was emphasized as a significant prognostic factor [6,8,[16][17][18]. In our study, histologic grade and tumor location were significant prognostic factors of OS in both univariate and multivariate analyses.…”

Section: Discussionsupporting

confidence: 66%

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A retrospective observational study on the treatment outcomes of 26 patients with spinal cord astrocytoma including two cases of malignant transformation

Ryu

Kim

et al. 2016

Eur Spine J

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Purpose To determine the biologic behavior and prognostic factors of spinal cord astrocytoma, we reviewed surgical and clinical outcomes. Due to the rarity of spinal cord astrocytoma, there is a lack of research regarding this type of tumor and malignant transformation. Methods We retrospectively reviewed the data from all patients on whom we performed spinal cord tumor removal between 1983 and 2014. Twenty-six patients were pathologically confirmed to have spinal cord astrocytoma or glioblastoma. Surgical extent and disease progression were confirmed by the surgeon based on operative findings, postoperative MRI, and outpatient department (OPD) follow-up. Results Pain or neurological deficit was the chief complaint for all patients. With MRI studies, there is a tendency for highgrade astrocytomas to show as enhanced and heterogeneous images. Two of the low-grade astrocytomas showed malignant transformation over the course of 4 and 11 months, respectively. The overall survival (OS) for low-grade astrocytoma was 28-480 months (mean 156.38 months); the OS for highgrade astrocytoma was 1-36 months (mean 12.00 months). Conclusions Two of 12 low-grade cases showed malignant transformations at 4 and 11 months, respectively, based on pathological confirmation. With spinal cord astrocytomas, enhanced MRI results appeared similar to those of a malignant lesion. We suggest close observation and image correlation of low-grade astrocytomas, even when pathologically confirmed as low-grade. In this review, we found that histologic grade is the most important prognostic factor, although it is not always concordant with biologic behaviors.

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Section: Discussionsupporting

confidence: 66%

“…Malignant spinal cord astrocytomas have particularly poor prognoses [7,9,15,16]. Herein, we analyzed behavioral patterns, prognosis factors, and treatment options of spinal cord astrocytoma, and we explored differences in these characteristics according to low-grade or high-grade astrocytoma.…”

Section: Discussionmentioning

confidence: 99%

A retrospective observational study on the treatment outcomes of 26 patients with spinal cord astrocytoma including two cases of malignant transformation

Ryu

Kim

et al. 2016

Eur Spine J

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“…In Japan, children with spinal cord tumors are more likely to be treated by neurosurgeons than by orthopedic spine surgeons. It is important to note that previous reports [17,24,25] indicate that in children, astrocytomas are 3-4 times more frequent than ependymomas. Another reason for our low percentage of astrocytomas is that when obviously malignant grade tumors as judged from imaging studies or clinical course were identified in our institutes, they were typically treated with radiation or chemotherapy, not surgically.…”

Section: Discussionmentioning

confidence: 93%

Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study

et al. 2012

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Purpose To clarify the relative frequency of various histopathological primary spinal cord tumors and their features in Japanese people and to compare this data with other reports. Methods Primary spinal cord tumor surgical cases from 2000 to 2009, which were registered in our affiliated hospital database were collected. We examined age at surgery, sex, anatomical location, vertebral level of the tumor, and pathological diagnosis in each case.Results Of the 678 patients in our study, 377 patients (55.6 %) were males and 301 patients (44.4 %) were females (male/female ratio 1.25). The mean age at surgery was 52.4 years. Of these tumors, 123 cases (18.1 %) were intramedullary, 371 cases (54.7 %) were intradural extramedullary, 28 cases (4.1 %) were epidural, and 155 cases (22.9 %) were dumbbell tumors. The pathological diagnoses included 388 schwannomas (57.2 %), 79 meningiomas (11.6 %), 54 ependymomas (8.0 %), 27 hemangiomas (4.0 %), 23 hemangioblastomas (3.4 %), 23 neurofibromas (3.4 %), and 9 astrocytomas (1.3 %). The male/female ratios for schwannomas, meningiomas, ependymomas,Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan e-mail: imagama@med.nagoya-u.ac.jp K. Sato Department of Orthopaedic Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya 466-8650, Japan (2012( ) 21:2019( -2026( DOI 10.1007( /s00586-012-2345 hemangiomas, hemangioblastomas, neurofibromas, malignant lymphomas, and lipomas are 1.4, 0.34, 1.3, 1.5, 2.3, 1.3, 2.7 and 2.3, respectively. Conclusion This is the first published research in English on the epidemiology of primary spinal cord tumors in Japanese people. Similar to other reports from Asian countries, our data indicates a higher male/female ratio overall for spinal cord tumors, a higher proportion of nerve sheath cell tumors, and a lower proportion of meningiomas and neuroepithelial tumors compared to reports from non-Asian countries. Data in the current study represent the characteristics of primary spinal cord tumors in Asian countries.

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“…Furthermore, MRI characteristics, which delineated a hypointense lesion relative to the spinal cord on T1-weighted imaging and hyperintense on T2-weighted image, are in keeping with the typical presentation of astrocytoma of the spinal cord [4,8]. The ideal surgical candidates for the resection of intramedullary spinal cord tumors (IMSCTs) are those who can still ambulate and in which the progressive development of weakness and sensory changes can be stalled or stopped [4,8].…”

Section: Dear Editormentioning

confidence: 99%

Pilocytic astrocytoma of the lower thoracic spine in an adult patient

et al. 2015

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Dear Editor,Although common in the pediatric population, pilocytic astrocytomas of the spinal cord become exceedingly rare with increasing age [5]. To our knowledge, only two case reports of adult patients diagnosed with pilocytic astrocytoma of the spinal cord have been described in the literature [3,9]. We report on the first case of an adult patient with pathologically confirmed pilocytic astrocytoma of the lower thoracic spine (T4-8).A 49-year-old woman presented to the Emergency Department with a fall secondary to increasing weakness in the left leg. The patient had a 2-year history of progressive left leg numbness and tingling radiating into her first toe. She also had progressive weakness in her left hip, knee and ankle but was still able to ambulate with difficulty. There were also bladder symptoms over the last 5 months including a slow urinary stream and overactive bladder that included urinating every 30 min. There was no urinary or bowel incontinence. Examination showed no evidence of systemic disease. Neurological examination revealed bilateral leg weakness. Right hip, knee, and ankle strength were 4/5 respectively. Left hip, knee, and ankle strength were each 4-/5. Patellar and ankle reflexes were hyperactive bilaterally. There was a T4 sensory level just below the breast.Imaging findings included a magnetic resonance imaging (MRI) of the thoracic and lumbar spine (Fig. 1). There was a large, intramedullary and intradural mass extending from T4-T8, severely compressing the thoracic spinal cord at the T6-T7 level.The patient underwent laminectomy from T4 to T8 and partial laminectomy at T3 and T9. After completing the laminectomy, intraoperative ultrasound was used to locate and delineate the lesion. The dura was opened and the tumor was gradually and delicately dissected from the inferior spinal cord between the nerve roots. A small portion of the lesion was left in the spinal cord as clear margins could not be delineated under the microscope and to avoid damage to the cord. The cord decompressed well after the lesion was excised. The pathological diagnosis was pilocytic astrocytoma World Health Organization (WHO) grade 1 (Fig. 2). At the 8-week post-operative mark in the rehabilitation facility, the patient needed help standing from a seated position and could only walk a few steps with no assistance.The patient's presentation of motor weakness was in line with the commonest initial presentation of astrocytoma of the spinal cord [2,4]. Furthermore, MRI

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Spinal Cord Astrocytomas: Presentation, Management, and Outcome

Cited by 37 publications

References 34 publications

A retrospective observational study on the treatment outcomes of 26 patients with spinal cord astrocytoma including two cases of malignant transformation

A retrospective observational study on the treatment outcomes of 26 patients with spinal cord astrocytoma including two cases of malignant transformation

Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study

Pilocytic astrocytoma of the lower thoracic spine in an adult patient

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