Long-term Functional Outcome of Intramedullary Spinal Cord Tumors after Surgical 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.

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Surgical treatment of intramedullary spinal cord metastases of systemic cancer: functional outcome and prognosis

Journal of Neuro-Oncology ◽

10.1007/s11060-004-4275-5 ◽

2005 ◽

Vol 73 (2) ◽

pp. 163-168 ◽

Cited By ~ 40

Author(s):

T. Gasser ◽

I. E. Sandalcioglu ◽

B. El. Hamalawi ◽

J. A. P. van de. Nes ◽

D. Stolke ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Functional Outcome ◽

Intramedullary Spinal Cord

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Surgical treatment of intramedullary spinal cord tumors: prognosis and complications

Spinal Cord ◽

10.1038/sj.sc.3102130 ◽

2007 ◽

Vol 46 (4) ◽

pp. 282-286 ◽

Cited By ~ 78

Author(s):

M Nakamura ◽

K Ishii ◽

K Watanabe ◽

T Tsuji ◽

H Takaishi ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord

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Long-term results in intramedullary spinal cord tumors

Clinical Neurology and Neurosurgery ◽

10.1016/s0303-8467(97)82218-4 ◽

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

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Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty

Journal of Neurosurgery Pediatrics ◽

10.3171/ped-08/01/057 ◽

2008 ◽

Vol 1 (1) ◽

pp. 57-62 ◽

Cited By ~ 76

Author(s):

Matthew J. McGirt ◽

Kaisorn L. Chaichana ◽

April Atiba ◽

Ali Bydon ◽

Timothy F. Witham ◽

...

Keyword(s):

Spinal Cord ◽

Functional Outcome ◽

Spinal Deformity ◽

Spinal Cord Tumor ◽

Extent Of Resection ◽

Neurological Function ◽

Karnofsky Performance Scale ◽

Duration Of Symptoms ◽

Intramedullary Spinal Cord

Object Gross-total resection of pediatric intramedullary spinal cord tumor (IMSCT) can be achieved in the majority of cases while preserving long-term neurological function. Nevertheless, postoperative progressive spinal deformity often complicates functional outcome years after surgery. The authors set out to determine whether laminoplasty in comparison with laminectomy has reduced the incidence of subsequent spinal deformity requiring fusion after IMSCT resection at their institution. Methods The first 144 consecutive patients undergoing resection of IMSCTs at a single institution underwent laminectomy with preservation of facet joints. The next 20 consecutive patients presenting for resection of IMSCTs underwent osteoplastic laminotomy regardless of patient or tumor characteristics. All patients were followed up with telephone interviews corroborated by medical records for the following outcomes: 1) neurological and functional status (modified McCormick Scale [MMS] score and Karnofsky Performance Scale [KPS] score); and 2) development of progressive spinal deformity requiring fusion. The incidence of progressive spinal deformity and the long-term neurological function were compared between the laminectomy and osteoplastic laminotomy cohorts. The means are expressed ± the standard deviation. Results Overall, the patients' mean age was 8.6 ± 5 years, and they presented with median MMS scores of 2 (interquartile range [IQR] 2–4). A > 95% resection was achieved in 125 cases (76%). There were no differences (p > 0.10) between patients treated with osteoplastic laminotomy and those treated with laminectomy in terms of the following characteristics: age; sex; duration of symptoms; location of tumor; incidence of preoperative scoliosis (Cobb angle > 10°: 7 [35%] with laminoplasty compared with 49 [34%] with laminectomy); involvement of the cervicothoracic junction (7 [35%] compared with 57 [40%]); thoracolumbar junction (4 [20%] compared with 36 [25%]); tumor size; extent of resection; radiation therapy; histopathological findings; or mean operative spinal levels (7.5 ± 2 compared with 7.5 ± 3). Nevertheless, patients who underwent osteoplastic laminotomy had better median preoperative MMS scores than those treated with laminectomy (2 [IQR 2–2] compared with 2 [IQR 2–4]; p = 0.04). A median of 3.5 years (IQR 1–7 years) after surgery, only 1 patient (5%) in the osteoplastic laminotomy cohort required fusion for progressive spinal deformity, compared with 43 (30%) in the laminectomy cohort (p = 0.027). Adjusting for the inter-cohort difference in preoperative MMS scores, osteoplastic laminotomy was associated with a 7-fold reduction in the odds of subsequent fusion for progressive spinal deformity (odds ratio 0.13, 95% confidence interval 0.02–1.00; p = 0.05). The median MMS and KPS scores were similar between patients who underwent osteoplastic laminotomy and those in whom laminectomy was performed (MMS Score 2 [IQR 2–3] for laminotomy compared with 2 [IQR 2–4] for laminectomy, p = 0.54; KPS Score 90 [IQR 70–100] for laminotomy compared with 90 [IQR 80–90] for laminectomy, p = 0.545) at a median of 3.5 years after surgery. Conclusions In the authors' experience, osteoplastic laminotomy for the resection of IMSCT in children was associated with a decreased incidence of progressive spinal deformity requiring fusion but did not affect long-term functional outcome. Laminoplasty used for pediatric IMSCT resection may decrease the incidence of progressive spinal deformity requiring subsequent spinal stabilization in some patients.

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Long-term Follow-up of Intramedullary Spinal Cord Tumors: A Series of 202 Cases

Neurosurgery ◽

10.1227/01.neu.0000158318.66568.cc ◽

2005 ◽

Cited By ~ 1

Keyword(s):

Spinal Cord ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Long Term Follow Up

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Institutional experience of surgical management of intramedullary spinal cord tumours

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20170925 ◽

2017 ◽

Vol 5 (4) ◽

pp. 1319 ◽

Cited By ~ 1

Author(s):

B. D. Bharath Singh Naik ◽

Kadali Satyavara Prasad ◽

Phaneeswar Thota ◽

Raman B. V. S.

Keyword(s):

Spinal Cord ◽

Functional Outcome ◽

Neurological Status ◽

Extent Of Resection ◽

Neurophysiological Monitoring ◽

Cervical Cord ◽

Radical Excision ◽

Spinal Cord Tumors ◽

Intramedullary Spinal Cord ◽

Common Location

Background: Intramedullary spinal cord tumors are rare entity accounting for only 5-6% of all central nervous system tumors. Much literature is not available regarding these tumors owing to their rarity. Present study includes 24 cases of intramedullary spinal cord tumors with pain and progressive weakness. Radiological evaluation showed various intramedullary lesions like ependymoma, astrocytoma, epidermoid etc. spreading over various levels of spinal cord like cervicomedullary, cervicodorsal and dorsal cords.Methods: The study included all the cases admitted with intramedullary spinal cord tumors in neurosurgery ward in King George hospital, Visakhapatnam, Andhra Pradesh, India during a period of three years from 2014 to 2016. Clinical profile of the patients was analyzed for the clinical presentation, age and sex distribution, histopathological study, pre-and postoperative neurological status, complications and functional outcome. All the patients are followed for a period of 6months to 3years.Results: Of the 24 cases, most common age group was second (7 patients) and third (7 patients) decades which is upto 29.16% each. Males (16 patients) are more affected than females in 66.66%. Ependymoma is the most common tumor seen in 41.66% (10 patients) followed by astrocytoma in 33.33% (8 patients). The surgical technique, extent of resection, pre and postoperative neurological status and functional outcome are discussed.Conclusions: Intramedullary tumours occur commonly among males in the 2nd to 4th decades. Among the intramedullary tumours ependymoma from the commonest lesion subtypes. Most common location is cervical cord segment. Ependymomas have a good plane of cleavage and are thus amenable to radical excision. Patients with good Mc Cormicks grade in pre-operative stage are more amenable for total or near total excision. Prognostic factors affecting outcome are the preoperative neurological status, the plane of cleavage, the extent of resection, the nature and subtype of the lesion. With the improvement in microsurgical techniques and novel adjunctive like MRI, CUSA and intraoperative neurophysiological monitoring, surgery for intramedullary lesions can be carried out with acceptable morbidity and mortality.

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