Surgical outcomes of pediatric spinal cord astrocytomas: systematic review and meta-analysis

Azad, Tej D.; Pendharkar, Arjun V; Pan, James; Huang, Yuhao; Li, Amy; Esparza, Rogelio; Mehta, Swapnil; Connolly, Ian D.; Veeravagu, Anand; Campen, Cynthia J.; Cheshier, Samuel; Edwards, Michael S. B.; Fisher, Paul G.; Grant, Gerald A.

doi:10.3171/2018.4.peds17587

Cited by 30 publications

(23 citation statements)

References 41 publications

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“…Data from 29 studies showed that most of the IMSCTs are in the cervical region (53.0%). 2 Brotchi et al 5 reported a higher percentage of cervical tumors (55.3%) than ours, whereas Bansal et al 3 and Kane et al 17 reported a lower percentage, 25% and 33%, respectively. At baseline, the median preoperative MMS of our patients was 3 (1-5).…”

Section: Discussioncontrasting

confidence: 51%

Factors Affecting Surgical Outcome of Intramedullary Spinal Cord Tumors: A Prospective One-year Follow-Up Study

Khalil

Aboul-Enein

Foad

et al. 2021

Egyptian Spine Journal

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Background Data: Identification of the prognostic factors of the surgical outcomes of intramedullary spinal cord tumors (IMSCTs) is essential. Many studies have established that early surgical intervention was associated with better outcomes and enhanced survival rates. Purpose: This study investigated the prognostic factors of the one-year surgical outcomes of patients with IMSCTs. Study Design: A prospective clinical case study. Patients and Methods: Twenty patients with IMSCTs, who underwent surgery in our institution and were followed up at our clinic were recruited for this study. Patients were followed up for one year to assess postoperative functional outcomes using the modified McCormick Scale (MMS). The reported parameters included preoperative MMS, use of operative monitoring, use of ultrasonic aspirator, the extent of tumor resection, and postoperative adjuvant therapy. Results: Operatively, 85% of patients underwent laminectomy, 55% reported growth total resection (GTR), 55% intraoperative monitoring, 75% underwent ultrasonic aspiration, 55% had syrinx, and 20% had duraplasty. The preoperative MMS improved from 3.0 to 2.32 and 2.42 postoperatively at six months and one year of follow-up, respectively. Patients with postoperative MMS ≤3 were more likely to undergo GTR with better postoperative MMS than those with preoperative MMS >3 at six-month follow-up (81.8% vs. 25%, respectively; p = 0.013) and at one-year follow-up (84.4 vs. 0%, respectively; p = 0.001). Good preoperative MMS, use of ultrasonic aspirator, and neuromonitoring were associated with better MMS. There were no significant associations between MMS at the sixth month and reported parameters including gender, symptoms duration, tumor location, bony work whether laminectomy or laminoplasty, number of segments involved, tumor histopathology, duraplasty, and postoperative adjuvant therapy. Conclusion:The findings of the current study showed that patients with GTR, good preoperative MMS, intraoperative monitoring, and ultrasonic aspirator usage might be associated with better functional outcomes. (2021ESJ229)

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Section: Discussioncontrasting

confidence: 51%

Factors Affecting Surgical Outcome of Intramedullary Spinal Cord Tumors: A Prospective One-year Follow-Up Study

Khalil

Aboul-Enein

Foad

et al. 2021

Egyptian Spine Journal

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“…According to previous literature, the pathological composition is the main determinant for patient survival and tumor progression for pediatric IM tumors [ 11 ]. However, the effect on OS and PFS of radical resection of IM tumors seems less clear [ 11 , 15 , 16 ], although some researchers advocated beneficial effects of total excision of tumors [ 2 , 4 , 8 , 12 ]. Constantini et al [ 11 ] reported that long-term PFS did not differ between groups with GTR and STR beyond 3 years postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Features of Primary Solitary Spinal Cord Tumors in Pediatric Patients : A 32-Year Single Institution Experience

Choi

Kim

Cho

et al. 2021

J Korean Neurosurg Soc

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Objective : Few studies exist on primary spinal cord tumors (PSCTs) in pediatric patients. The purpose of this study was to perform descriptive analysis and detailed survival analysis for PSCTs. Methods : Between 1985 and 2017, 126 pediatric patients (male : female, 56 : 70) with PSCTs underwent surgery in a single institution. We retrospectively analyzed data regarding demographics, tumor characteristics, outcomes, and survival statistics. Subgroup analysis was performed for the intramedullary (IM) tumors and extradural (ED) tumors separately. Results : The mean age of the participants was 6.4±5.04 years, and the mean follow-up time was 69.5±46.30 months. The most common compartment was the ED compartment (n=57, 45.2%), followed by the IM (n=43, 34.1%) and intradural extramedullary (IDEM; n=16, 12.7%) compartments. Approximately half of PSCTs were malignant (n=69, 54.8%). The most common pathologies were schwannomas (n=14) and neuroblastomas (n=14). Twenty-two patients (17.5%) died from the disease, with a mean disease duration of 15.8±15.85 months. Thirty-six patients (28.6%) suffered from progression, with a mean period of 22.6±30.81 months. The 10-year overall survival (OS) rates and progression-free survival (PFS) rates were 81% and 66%, respectively. Regarding IM tumors, the 10-year OS rates and PFS rates were 79% and 57%, respectively. In ED tumors, the 10-year OS rates and PFS rates were 80% and 81%, respectively. Pathology and the extent of resection showed beneficial effects on OS for total PSCTs, IM tumors, and ED tumors. PFS was affected by both the extent of removal and pathology in total PSCTs and ED tumors; however, pathology was a main determinant of PFS rather than the extent of removal in IM tumors. The degree of improvement in the modified McCormick scale showed a trend towards improvement in patients with IM tumors who achieved gross total removal (p=0.447). Conclusion :Approximately half of PSCTs were malignant, and ED tumors were most common. The most common pathologies were schwannomas and neuroblastomas. Both the pathology and extent of resection had a decisive effect on OS. For IM tumors, pathology was a main determinant of PFS rather than the extent of removal. Radical excision of IM tumors could be a viable option for better survival without an increased risk of worse functional outcomes.

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“…These tumors are predominantly glial in origin, account for approximately 10–20% of all spinal tumors, and occur with less frequency than their histopathologic intracranial counterparts 1,2 . The optimal treatment of IMSCTs is maximal safe surgical resection, with adjuvant chemotherapy and radiation therapy (RT) playing a role in recurrent or progressive residual disease, as well as cases in which morbidity associated with surgical intervention is thought to be too high 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Genomic Landscape of Intramedullary Spinal Cord Gliomas

Zhang

Iyer

Azad

et al. 2019

Sci Rep

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Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms that have limited treatment options and are associated with high rates of morbidity and mortality. To better understand the genetic basis of these tumors we performed whole exome sequencing on 45 tumors and matched germline DNA, including twenty-nine spinal cord ependymomas and sixteen astrocytomas. Though recurrent somatic mutations in IMSCTs were rare, we identified NF2 mutations in 15.7% of tumors (ependymoma, N = 7; astrocytoma, N = 1), RP1 mutations in 5.9% of tumors (ependymoma, N = 3), and ESX1 mutations in 5.9% of tumors (ependymoma, N = 3). We further identified copy number amplifications in CTU1 in 25% of myxopapillary ependymomas. Given the paucity of somatic driver mutations, we further performed whole-genome sequencing of 12 tumors (ependymoma, N = 9; astrocytoma, N = 3). Overall, we observed that IMSCTs with intracranial histologic counterparts (e.g. glioblastoma) did not harbor the canonical mutations associated with their intracranial counterparts. Our findings suggest that the origin of IMSCTs may be distinct from tumors arising within other compartments of the central nervous system and provides the framework to begin more biologically based therapeutic strategies.

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Surgical outcomes of pediatric spinal cord astrocytomas: systematic review and meta-analysis

Cited by 30 publications

References 41 publications

Factors Affecting Surgical Outcome of Intramedullary Spinal Cord Tumors: A Prospective One-year Follow-Up Study

Factors Affecting Surgical Outcome of Intramedullary Spinal Cord Tumors: A Prospective One-year Follow-Up Study

Clinicopathological Features of Primary Solitary Spinal Cord Tumors in Pediatric Patients : A 32-Year Single Institution Experience

Genomic Landscape of Intramedullary Spinal Cord Gliomas

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