Surgical treatment of intramedullary spinal cord tumors: prognosis and complications

Abstract

Study design: Retrospective case series. Objective: To evaluate our recent treatment strategy for intramedullary spinal cord tumors. Setting: Department of Orthopaedic Surgery, Keio University, Japan. Methods: We reviewed 68 cases of intramedullary tumors (ependymoma, 33; astrocytoma, 23; hemangioblastoma, 12), treated surgically between 1994 and 2003. There were 42 males and 26 females whose mean age at the time of surgery was 43 years. The mean follow-up period was 6.2 years. The tumor malignancy grade according to the WHO classification was astrocytoma grade I, 3; grade II, 8 (low-grade: 11 cases); grade III, 10; grade IV, 2 (high-grade: 12 cases). All ependymomas were grade II. Three of the 12 hemangioblastomas were associated with von Hippel-Lindau disease. Results: Total excision was achieved in 90% of the ependymomas and functional improvement was obtained when the preoperative neurological deficit was mild. Approximately 50% of low-grade astrocytomas could be totally excised with favorable survival outcomes, suggesting that total excision should be attempted for low-grade astrocytomas. However, total excision of high-grade tumors was difficult and the functional outcomes were poor. Cordotomy should be considered in patients with a thoracic high-grade astrocytoma. Total resection was possible in 92% of hemangioblastoma, and the functional outcomes were good, however, more attention should be paid for tumors with feeding arteries on the ventral side and for those associated with von Hippel-Lindau disease. Conclusions: Predictors of good surgical outcome for intramedullary spinal cord tumors were histological grades of the tumors, surgical margins, and neurological status of the patient before surgery.

Progression of paralysis is the most useful factor for differentiating malignant from benign intramedullary tumors

“…8 Although surgical treatment of malignant intramedullary tumors, especially primary malignant tumors, is extremely difficult, transection of the spinal cord has been advocated, and can be a lifesaving option in some cases. 9,10 In the present series, progression of paralysis was rapid in almost all patients with malignant intramedullary tumors, and this was well reflected in their loss of walking ability. Similar findings have been reported in the cases with malignant astrocytomas, 1,5,11 a malignant lymphoma 12 and metastatic tumors.…”

Prognostic factors in intramedullary astrocytomas: a literature review

“…For statistical purposes, these patients are frequently grouped together with those undergoing less extensive resection (STR or PR) [5,9,22,30,34,49,51,52,59] to increase sample size and statistical power. Clearly, treatment efficacy of GTR cannot be detected this way, although inferior results of less extensive resection or biopsy may be proven [51].…”

“…Statistical analysis reporting tumor location as a prognostic factor was reported in nine studies [2,24,27,28,30,34,49,51,52] (Table 8). Of these, five were classified as category A, four did not report any significant relationship between tumor location and outcome [24,28,30,34], only (8) 13 (100) 6 (46) (23) 39 (68) 10 (17) Minehan [49] found significantly ''increased'' survival in patients with thoracic spinal cord involvement.…”

“…Results for EOR specifically for HG histology were reported in nine studies, four were classified as category A [5,15,34,46], five as category B [11,27,51,52,65] (Table 13, lower part). Only one category A study reported increased 4-year OS in anaplastic astrocytoma (grade III) patients [46]; those receiving GTR had significantly improved survival (78% at 5 years) when compared to patients with STR (38% at 5 years, p = 0.028).…”

Cervical Ependymoma:Case Report and Review of the Literature

“…Surgery is the best treatment for ependymoma as it delivers a histological diagnosis and prevents long-term neurological dysfunction (Kothbauer, 2007). According to Nakamura and colleaguescomplete resection was accomplished in 30 (91%) of the 33 cases (Nakamura et al, 2008). Although recurrence is unusual, radiotherapy is indicated in those with subtotal resections or with recurrent tumours.…”