Ten years’ experience in the management of spinal intramedullary tumors in a single institution

Bansal, Sumit; Ailawadhi, Pankaj; Suri, Ashish; Kale, Shashank Sharad; Chandra, P. Sarat; Singh, Manmohan; Kumar, Rajender; Sharma, Bhawani S.; Mahapatra, Ashok Kumar; Sharma, Mehar Chand; Sarkar, Chitra; Bithal, Pramod; Dash, Hari H.; Gaikwad, Shailesh; Mishra, Nidhi

doi:10.1016/j.jocn.2012.01.056

Cited by 29 publications

(32 citation statements)

References 37 publications

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“…[18101114] We did not observe permanent functional deterioration in our case series; on the contrary, a high degree of improvement was achieved. Dysesthesias were present in patients who already had it in the preoperative assessment, and in all of the cases, there was improvement through pregabalin in personalized doses.…”

Section: Discussioncontrasting

confidence: 53%

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Extent of resection and postoperative functional declination of Klekamp′s type A intramedullary tumors in adult patients

2016

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Background:The most commonly primary intramedullary spinal cord tumors (ISCT) in adults are the noninfiltrative lesions, corresponding to Klekamp's type A classification. There are few reports exclusively considering this type of lesions, their resectability and postoperative functional declination risk, and to our knowledge, none from Latin America. This led us to evaluate our results to provide information that might contribute to the decision making process in our region.Methods:A retrospective observational study was conducted comprising a cohort of 21 adults having primary Klekamp's type A ISCT. Diagnosis was made by magnetic resonance imaging (MRI), along with diffusion tensor/tractography in the last 7 cases. Preoperative functional status was assessed using the McCormick's modified scale (mMs), which was also used for the postoperative assessment within postoperative 90 days period. MRI was used to confirm the extent of resection.Results:Radical resection was obtained in 20/21 cases. The postoperative functional status was stable in 42.8% of the cases, and in 57.4% was even better than in the preoperative period. Temporary declination was observed in 2 cases in the early postoperative period. There were 2 cases with complications; one patient had cerebrospinal fluid fistula with meningitis, which was conservatively resolved, and another patient died from pulmonary embolism.Conclusion:Although the number of patients in this series does not allow to conclude from a statistical point of view, the outcomes showed that the modern surgery of Klekamp's type A ISCT permits a complete resection with low functional declination risk.

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Section: Discussioncontrasting

confidence: 53%

“…Published literature, mostly in the pediatrics field, show that the better the preoperative status is, the higher the expectation of neurological preservation becomes. [12568910111214]…”

Section: Introductionmentioning

confidence: 99%

Extent of resection and postoperative functional declination of Klekamp′s type A intramedullary tumors in adult patients

2016

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“…Similar male to female ratio has been reported by other studies from India. [ 8 9 ] We observed that all histopathological subtypes, except meningioma, were more common in males as compared to females (in this series, 6/7 patients with meningioma were females). The female preponderence of meningioma is a well-known entity[ 6 10 11 12 ] and our study also supports it.…”

Section: Discussionmentioning

confidence: 65%

“…The mean age of IMSCTs in our series is less as compared to that of the western world[ 5 ] but was comparable to Indian reports. [ 8 9 ] This is due to the presence of significant number of pediatric patients in this subgroup (16/41; 39%).…”

Section: Discussionmentioning

confidence: 99%

Spinal tumors: Trends from Northern India

Arora

Kumar

2015

Asian J Neurosurg

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Introduction and Methods:We retrospectively analyzed 111 patients with spinal tumors operated over a period of 9 years to observe the relative frequency of different lesions, their clinical profile, functional outcome and prognostic factors. 30/111 (27%) were extradural, 40/111 (36.1%) were intradural extramedullary (IDEM) and 41/111 (36.9%) were intramedullary spinal cord tumors (IMSCTs). Mean age at surgery was 30.81 years (range 1–73 years). The average preoperative duration of symptoms was 16.17 months (15 days to 15 years). Major diagnoses were ependymomas and astrocytomas in IMSCT group, schwanommas and neurofibromas in IDEM group, and metastasis, lymphoma in extradural group. The common clinical features were motor weakness in 78/111 (70.27%), sensory loss in 55/111 (49.54%), pain 46/111 (41.44%), and sphincter involvement in 47/111 (42.43%) cases.Results:Totally, 88/111 (79.27%) patients had improvement in their functional status, 17/111 (15.31%) remained same, and 6/111 (5.4%) were worse at time of their last follow-up. The mean follow-up was 15.64 months (1.5 m−10 years). Totally, 59 out of 79 patients, who were dependent initially, were ambulatory with or without the aid. Most common complication was persistent pain in 10/111 (9%) patients and nonimprovement of bladder/bowel symptoms in 7/111 (6.3%). One patient died 3 months after surgery.Conclusions:(1) Congenital malformative tumors like epidermoids/dermoids (unrelated to spina bifida) occur more frequently, whereas the incidence of spinal meningioma is less in developing countries than western populations. (2) The incidence of intramedullary tumors approaches to that of IDEM tumors. Intramedullary tumors present at a younger age in developing countries. (3) Rare histological variants like primitive neuroectodermal tumors should also be considered for histological differential diagnosis of spinal tumors. (4) Preoperative neurologic status is the most important factor related to outcome in spinal tumors.

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“…3,11,13,24 A series of publications have already reported good outcomes (using the mMS) and determined the safety and efficacy of the best possible microsurgical tumor removal with the aid of intraoperative neurophysiological monitoring. 1,2,[5][6][7][8]12,14,17,18,21,25 No significant overall impact on reported QOL can be measured using the PedsQL 4.0 when comparing children with IMSCT and a healthy collective. There is only one minor exception to this conclusion: in the physical health item of the CSR score in the low-grade subgroup (Fig.…”

Section: Discussionmentioning

confidence: 99%

Quality of life after surgical treatment of primary intramedullary spinal cord tumors in children

Schneider¹,

Hidalgo²,

Schmitt‐Mechelke

et al. 2014

PED

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Object Presently, the best available treatment for intramedullary spinal cord tumors (IMSCTs) in children is microsurgery with the objective of maximal tumor removal and minimal neurological morbidity. The latter has become manageable with the development and standard use of intraoperative neurophysiological monitoring. Traditionally, the perioperative neurological evaluation is based on surgical or spinal cord injury scores focusing on sensorimotor function. Little is known about the quality of life after such operations; therefore, this study was designed to investigate the impact of surgery for IMSCTs on the quality of life in children. Methods Twelve consecutive pediatric patients treated for IMSCT were included in this retrospective fixed cohort study. A multidimensional questionnaire-based quality of life instrument, the Pediatric Quality of Life Questionnaire version 4 (PedsQL 4.0), was chosen to analyze follow-up data. This validated instrument particularly allows for a comparison between a patient cohort and a healthy pediatric sample population. Results Of 11 mailed questionnaires (1 patient had died of progressive disease), 10 were returned, resulting in a response rate of 91%. There were 8 low-grade lesions (5 pilocytic astrocytomas, 1 ganglioglioma, 1 hemangioblastoma, and 1 cavernoma) and 4 high-grade lesions (2 anaplastic gangliogliomas, 1 glioblastoma, and 1 glioneuronal tumor). The mean age at diagnosis was 7.5 years, the mean follow-up was 4.2 years, and 83% of the patients were male. Total resection was achieved in 5 patients and subtotal resection in 7. Four patients had undergone 2 or more resections. The 4 patients with high-grade tumors and 2 with incompletely resected low-grade tumors underwent adjuvant treatment (2 chemotherapy and 4 both radiotherapy and chemotherapy). The mean modified McCormick Scale score at the time of diagnosis was 1.7; at the time of follow-up, 1.5. The mean PedsQL 4.0 total score in the low-grade group was 78.5; in the high-grade group, 82.6. There was no significant difference in PedsQL 4.0 scores between the patient cohort and the normal population. Conclusions In a small cohort of children who had undergone surgery for IMSCTs with a mean follow-up of 4.2 years, quality of life scores according to the PedsQL 4.0 instrument were not different from those in a normal sample population.

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Ten years’ experience in the management of spinal intramedullary tumors in a single institution

Cited by 29 publications

References 37 publications

Extent of resection and postoperative functional declination of Klekamp′s type A intramedullary tumors in adult patients

Extent of resection and postoperative functional declination of Klekamp′s type A intramedullary tumors in adult patients

Spinal tumors: Trends from Northern India

Quality of life after surgical treatment of primary intramedullary spinal cord tumors in children

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