Surgical management of spinal intramedullary tumors: Ten-year experience in a single institution

Alizada, Orkhan; Kemerdere, Rahşan; Ulu, Mustafa Onur; Akgün, Mehmet Yiğit; İşler, Cihan; Kızılkılıç, Osman; Hancı, Murat

doi:10.1016/j.jocn.2019.12.054

Cited by 23 publications

(13 citation statements)

References 41 publications

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“…Our findings are consistent with literature reports. [ 6 , 21 , 22 ] In the study by Chang et al, of 31 patients with spinal enpendymomas, 11 (35%) with preoperative Nurick's grade < 4 showed improvement in neurological status, whereas those with preoperative Nurick's grade = 4 showed poorer neurological status ( P = .05). This study suggested that patients with worse preoperative neurological statuses had fewer opportunities for neurological improvement.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging indicators for neurological outcome after surgery in patients with intramedullary spinal ependymomas

Bai

Zhao

et al. 2022

Medicine

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This is a retrospective study. The aim of this study was to determine the indicators of neurological outcome after surgery in patients with intramedullary spinal ependymomas by using magnetic resonance imaging (MRI). A total of 106 consecutive patients (mean age: 42.4 ± 1.3 years; 52.8% male) diagnosed with intramedullary spinal ependymomas were retrospectively recruited. All patients underwent spine MRI and subsequent surgical resection for the spinal tumors. Data regarding clinical symptoms and pathological grades of tumors were collected from clinical records. The McCormick score was used for grading patients’ neurological status before and after surgery at 12 months. Good outcome was defined as stable McCormick score (McC) score (no change of McC score between preoperation and post-operation at 12 months) or improvement in McC score (post-operative McC score at 12 months < preoperative McC score). Poor outcome was determined when there was an increase in McC score at 12 months after surgery. The MRI characteristics of spinal ependymomas between patients with good and poor neurological outcomes were compared. Logistic regression was performed to assess the association between MRI characteristics of tumors and post-operative neurological outcomes. Patients with poor neurological outcomes had larger longitudinal length (4.7 ± 0.5 vs 3.3 ± 0.2, P = .004) and higher enhancement signal-to-noise-ratio (SNR) (102.4 ± 12.3 vs 72.8 ± 4.6, P = .022) than those with good neurological outcomes. After adjusting for confounding factors, longitudinal length (OR, 0.768; 95% CI, 0.604–0.976; P = .031) and enhancement SNR (OR, 0.988; 95% CI, 0.978–0.999; P = .026) of spinal ependymomas were significantly associated with poor neurological prognosis. The longitudinal length of tumor and enhancement SNR on T1-weighted images are independently associated with neurological outcome after surgery.

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging indicators for neurological outcome after surgery in patients with intramedullary spinal ependymomas

Bai

Zhao

et al. 2022

Medicine

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“…Postsurgical functional outcomes in spinal intramedullary tumors have been cited as approximately 23% of patients showing neurologic worsening in the immediate postoperative period with 14% developing permanent disability. 20 In our cases, deficits after surgical intervention included hemiparesis, proprioceptive impairment, spasticity, and neurogenic bowel and bladder. Proprioceptive deficits were the main functional impairments for 2 of our 3 cases.…”

Section: Discussionmentioning

confidence: 69%

Primary Melanocytomas of the Spinal Cord: Case Studies and Rehabilitation Perspectives

Covington

Severson

Shaeffer

et al. 2021

Archives of Rehabilitation Research and Clinical Translation

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Primary melanocytomas of the central nervous system are rare tumors arising from leptomeningeal melanocytes. Only 29 cases have been reported in the literature. Presenting symptoms may include insidious onset of back pain, slowly progressive neurologic deficits such as weakness and sensory changes, and bowel and bladder dysregulation. Advanced imaging including magnetic resonance imaging can be helpful in lesion localization but does not distinguish between primary and metastatic melanoma. In this case series, we present 3 patients with nontraumatic spinal cord injuries secondary to primary central nervous system malignant melanocytomas who were admitted to a single inpatient rehabilitation facility within a 12-month time frame. These cases highlight the importance of the rehabilitation team in the continuum of care for patients undergoing resection of primary melanocytomas of the spinal cord. The rehabilitation team should be involved in the preoperative counseling setting, immediately postoperatively, and in follow-up care to assess for signs of recurrence. A comprehensive multidisciplinary approach including physical and occupational therapists, rehabilitation nurses, rehabilitation neuropsychologists, and physiatrists is important for optimizing the function of these patients.

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“…Neurologic outcomes have garnered increasing attention for patients affected by SE given their impact on quality of life and the healthcare system [ 3 , 14 ]. Although conservative management may be a viable option for some patients [ 15 ], surgical resection remains the mainstay of SE treatment [ 16 , 17 ]. Despite the relatively fair prognosis for SE, poor outcomes have been shown to be associated with preoperative neurologic deficits, multisegmental disease, older age, thoracic tumor location, higher tumor grade, and STR [ 3 , 14 , 18 - 20 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term Neurologic Outcome After Spinal Ependymoma Resection With Multimodal Intraoperative Electrophysiological Recording: Cohort Study and Review of the Literature

et al. 2022

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Objective: To evaluate how multimodal intraoperative neuromonitoring (IONM) changes during spinal ependymoma (SE) resection correlate with long-term neuro-functional outcomes.Methods: A retrospective analysis of patients aged 18 years or older who underwent surgical resection for SE over a 10-year period was conducted. IONM changes were defined as sustained transcranial motor evoked potential (TcMEP) and/or somatosensory evoked potential (SSEP) signal decrease of 50% or greater from baseline. Primary endpoints were postoperative modified McCormick Neurologic Scale (MNS) scores at postoperative day (POD) < 2, 6 weeks, 1 year, and 2 years. Univariate and multivariate analyses were performed.Results: Twenty-nine patients were identified. Average age was 44.2 ± 15.4 years. Sixteen (55.2%) were male and 13 (44.8%) were female. Tumor location was 10 cervical-predominant (34.5%), 13 thoracic-predominant (44.8%), and 6 lumbar/conus-predominant (20.7%). A majority (69.0%) were World Health Organization grade 2 tumors. Twentyfour patients (82.8%) achieved gross total resection. Thirteen patients (44.8%) had a sustained documented IONM signal change and 10 (34.5%) had a TcMEP change with or without derangement in SSEP. At POD < 2, 6 weeks, 1 year, and 2 years, MNS was significantly higher for those when analyzing subgroups with either any sustained IONM or TcMEP ± SSEP signal attenuation > 50% below baseline (all p < 0.05).Conclusion: Sustained IONM derangements > 50% below baseline, particularly for TcMEP, are significantly associated with higher MNS postoperatively out to 2 years. Intraoperative and postoperative management of these patients warrant special consideration to limit neurologic morbidity.

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Surgical management of spinal intramedullary tumors: Ten-year experience in a single institution

Cited by 23 publications

References 41 publications

Magnetic resonance imaging indicators for neurological outcome after surgery in patients with intramedullary spinal ependymomas

Magnetic resonance imaging indicators for neurological outcome after surgery in patients with intramedullary spinal ependymomas

Primary Melanocytomas of the Spinal Cord: Case Studies and Rehabilitation Perspectives

Long-term Neurologic Outcome After Spinal Ependymoma Resection With Multimodal Intraoperative Electrophysiological Recording: Cohort Study and Review of the Literature

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