Intramedullary Spinal Cord Tumors

2018 ◽  
Author(s):  
Paul C. McCormick
Keyword(s):  
Spinal Cord ◽  
Transverse Myelitis ◽  
Tumor Control ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Inflammatory Conditions ◽  
Optimal Patient Outcome ◽  
Spinal Cord Dysfunction ◽  
Slow Growing

Intramedullary spinal cord tumors represent a heterogeneous group of neoplasms that may cause progressive spinal cord dysfunction. With few exceptions, however, most are slow-growing, biologically indolent neoplasms for which surgery is the treatment of choice. Long-term tumor control with preservation of neurological function is achievable in most patients. Challenges to the evaluation and management of these lesions include accurate differentiation of these tumors from inflammatory conditions such as transverse myelitis, sarcoidosis, and demyelinating conditions; the management of patients with asymptomatic tumors; and the timing and techniques of surgery to achieve the optimal patient outcome.

Outcome after Operative Treatment of Intramedullary Spinal Cord Tumors in Adults: Intermediate and Long-Term Results in 51 Patients

Neurosurgery ◽  
1989 ◽  
Vol 25 (6) ◽  
pp. 855-859 ◽  
Author(s):  
Paul R. Cooper
Keyword(s):  
Spinal Cord ◽  
Operative Treatment ◽  
Extent Of Resection ◽  
Long Term Results ◽  
Spinal Cord Tumors ◽  
Term Outcome ◽  
Intramedullary Spinal Cord ◽  
Long Term Outcome ◽  
Results Of Treatment

Abstract The reported results of treatment of intramedullary spinal cord tumors (IMSCT) are difficult to interpret because of heterogeneous management strategies, small numbers of patients, and short periods of follow-up. In 1985 we published the early results of operative treatment of 29 patients with IMSCT and were cautiously optimistic that aggressive operative management would have a salutary effect on long-term outcome. In this report, the most recent clinical status of these 29 original patients is reviewed, along with that of 22 additional ones, to assess the intermediate and long-term results of treatment of IMSCT in 51 patients who underwent microsurgical resection between 1981 and 1987. Of these 51 patients, 24 had ependymomas, 18 had astrocytomas, and the remainder had a variety of less common lesions. Thirty-seven patients survive and have been followed for periods up to 72 months (mean 38 months). The neurological conditions of 21 patients are improved or have stabilized following operation. The conditions of 16 patients are worse postoperatively: 11 from operation and 5 from progression of disease. Eight patients are neurologically intact, 7 walk independently but abnormally, 9 ambulate with the aid of a cane or walker, and the remaining 13 are not ambulatory. Twelve of 18 patients with astrocytomas and 2 of 24 patients with ependymomas have died after a mean survival of 10 months from operation. Patients with ependymomas who had gross total resection have fared the best, with no deaths or recurrences, but no relationship could be discerned between the extent of resection and outcome in patients with astrocytomas. The author concludes that radical resection of IMSCT may be performed with initial stabilization or improvement of neurological function in the majority of patients. In patients with ependymomas the extent of resection correlated well with long-term outcome. In patients with astrocytomas. however, there was no such relationship. All 7 patients with astrocytomas of Grades III and IV have died, as have 4 of 11 patients with astrocytomas of Grades I and II.

Long-term results in intramedullary spinal cord tumors

1997 ◽  
Vol 99 ◽  
pp. S204
Author(s):  
J. Náhlovský ◽  
R. Malec ◽  
I. Látr ◽  
K. Kaltofen ◽  
M. Šercl
Keyword(s):  
Spinal Cord ◽  
Long Term Results ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord

scholarly journals Long-term Functional Outcome of Intramedullary Spinal Cord Tumors after Surgical Treatment

2003 ◽  
Vol 17 (2) ◽  
pp. 89-98 ◽  
Author(s):  
Misao Nishikawa ◽  
Kenji Ohata ◽  
Akimasa Nishio ◽  
Toshihiro Takami ◽  
Takeo Goto ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Functional Outcome ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord

scholarly journals Delayed variations in the diagnostic accuracy of intraoperative neuromonitoring in the resection of intramedullary spinal cord tumors

2021 ◽  
Vol 50 (5) ◽  
pp. E21
Author(s):  
Gil Kimchi ◽  
Nachshon Knoller ◽  
Akiva Korn ◽  
Yahel Eyal-Mazuz ◽  
Yechiam Sapir ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Diagnostic Accuracy ◽  
Postoperative Period ◽  
Intraoperative Neuromonitoring ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Over Time ◽  
D Wave

OBJECTIVE The use of intraoperative neuromonitoring (IONM) has become an imperative adjunct to the resection of intramedullary spinal cord tumors (IMSCTs). While the diagnostic utility of IONM during the immediate postoperative period has been previously studied, its long-term diagnostic accuracy has seldom been thoroughly assessed. The aim of this study was to evaluate long-term variations in the diagnostic accuracy of transcranial motor evoked potentials (tcMEPs), somatosensory evoked potentials (SSEPs), and D-wave recordings during IMSCT excision. METHODS The authors performed a retrospective evaluation of imaging studies, patient charts, operative reports, and IONM recordings of patients who were operated on for gross-total or subtotal resection of IMSCTs at a single institution between 2012 and 2018. Variations in the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) for postoperative functional outcome (McCormick Scale) were analyzed at postoperative day 1 (POD1), 6 weeks postoperatively (PO-6 weeks), and at the latest follow-up. RESULTS Overall, 28 patients were included. The mean length of follow-up was 19 ± 23.4 months. Persistent motor attenuations occurred in 71.4% of the cohort. MEP was the most sensitive modality (78.6%, 87.5%, and 85.7% sensitivity at POD1, PO-6 weeks, and last follow-up, respectively). The specificity of the D-wave was the most consistent over time (100%, 83.35%, and 90% specificity at the aforementioned time points). The PPV of motor recordings decreased over time (58% vs 33% and 100% vs 0 for tcMEP and D-wave at POD1 and last follow-up, respectively), while their NPV consistently increased (67% vs 89% and 70% vs 100% for tcMEP and D-wave at POD1 and last follow-up, respectively). CONCLUSIONS The diagnostic accuracy of IONM in the resection of IMSCTs varies during the postoperative period. The decrease in the PPV of motor recordings over time suggests that this method is more predictive of short-term rather than long-term neurological deficits. The increasing NPV of motor recordings indicates a higher diagnostic accuracy in the identification of patients who preserve neurological function, albeit with an increased proportion of false-negative alarms for the immediate postoperative period. These variations should be considered in the surgical decision-making process when weighing the risk of resection-associated neurological injury against the implications of incomplete tumor resection.

Resection of intramedullary spinal cord tumors in children: assessment of long-term motor and sensory deficits

2008 ◽  
Vol 1 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Matthew J. McGirt ◽  
Kaisorn L. Chaichana ◽  
April Atiba ◽  
Frank Attenello ◽  
Kevin C. Yao ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neurological Deficit ◽  
Neurological Function ◽  
Older Age ◽  
Urinary Dysfunction ◽  
Symptom Duration ◽  
Spinal Cord Tumors ◽  
Duration Of Symptoms ◽  
Intramedullary Spinal Cord

Object With modern surgical advances, radical resection of pediatric intramedullary spinal cord tumors (IMSCTs) can be expected to preserve long-term neurological function. Nevertheless, postoperative neurological decline is not uncommon after surgery, and many patients continue to experience long-term dysesthetic symptoms. Preoperative predictors of postoperative neurological decline and sensory syndromes have not been investigated and may serve as a guide for surgical risk stratification. Methods Neurological function (as determined using the modified McCormick Scale [mMS]) preoperatively, postoperatively, and 3 months after surgery was retrospectively recorded from patient charts in 164 consecutive patients undergoing resection of IMSCTs. A median 4 years (interquartile range [IQR] 1–8 years) after surgery, long-term motor and sensory symptoms were assessed by telephone interviews and corroborated by subsequent medical visits in 120 available patients. This long-term assessment was retrospectively reviewed for the purposes of this study. The authors reviewed this series to assess long-term motor, sensory, and urinary outcomes and to determine independent risk factors of postoperative neurological decline and long-term sensory dysfunction. Results Patients were 8.6 ± 5.7 years old and presented with a median mMS of 2 (IQR 2–4). Three months after surgery, 38 patients (23%) continued to experience decreased neurological function (1 mMS point) incurred perioperatively. Increasing age (p = 0.028), unilateral symptoms (p = 0.046), and urinary dysfunction at presentation (p = 0.004) independently predicted persistent 3-month perioperative decline. At long-term follow-up (median 4 years), 39 (33%) exhibited improvements in their mMS scores, 13 (30%) had improvement in their urinary dysfunction, and 27 (30%) had resolution of their dysesthesias. Seventy-eight patients (65%) experienced long-term dysesthetic symptoms. Increasing age (p = 0.024), preoperative symptom duration > 12 months (p = 0.027), and worsened postoperative mMS score at hospital discharge (p = 0.013) independently increased the risk of long-term dysesthesias. Conclusions In the authors' experience, nearly one third of patients may experience improvement in motor, sensory, and urinary dysfunction years after IMSCT resection, whereas the majority will continue to experience long-term dysesthetic symptoms. Improvement in motor deficits preceded improvement in sensory syndromes, and urinary dysfunction typically resolved much longer after surgery. The risk of persistent perioperative motor decline was increased with older age, unilateral symptoms, preoperative urinary symptoms, and less severe preoperative neurological deficit. The risk of long-term dysesthesias was increased with older age, increased duration of symptoms prior to resection, and greater postoperative neurological deficit.

Thoracic intramedullary melanocytoma with long-term follow-up

2008 ◽  
Vol 9 (6) ◽  
pp. 589-592 ◽  
Author(s):  
Geeta Chacko ◽  
Vedantam Rajshekhar
Keyword(s):  
Spinal Cord ◽  
Differential Diagnosis ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Long Term Follow Up

Melanocytomas are tumors of the neuraxis seen predominantly in adults. The authors report a case of a thoracic intramedullary melanocytoma with long-term follow-up of 8 years postsurgery. Melanocytomas, although rare, must be included in the differential diagnosis of intramedullary spinal cord tumors.

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