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

      Abstract

      We retrospectively reviewed the outcomes of 195 patients with intramedullary tumors who underwent surgery between January 2001 and December 2010 at a single institution. The symptomatology, neurological and neuroradiological findings, operative details, perioperative and postoperative complications, histopathological data and follow-up examinations of the 137 (70.2%) males and 58 (29.7%) females were studied and analyzed. Epidermoid was the most common intramedullary tumour in children (23%), whereas in adults, ependymomas were more common (46%). Ependymomas were more amenable to resection (total excision in 57.7% and near-total excision in 39.4%) as compared to astrocytomas (total excision in 29%; near total excision in 60.5%). At the final clinical follow-up, 24 patients (16.4%) had improved in McCormick grade, 112 patients (76.7%) remained unchanged and 11 patients (7.5%) had worsened. Complete removal of the lesion is the primary goal of surgery. We conclude that the strongest predictor of functional outcome was the preoperative neurological condition, beyond the histological differentiation of the intramedullary tumor.

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      References

        • Stein B.M.
        • McCormick P.C.
        Intramedullary neoplasms and vascular malformation.
        Clin Neurosurg. 1992; 39: 361-387
        • Constantini S.
        • Epstein F.
        Primary spinal cord tumors.
        in: Levin A.V. Cancer in central nervous system. Churchill Livingstone, New York1994: 127-138
        • Constantini S.
        • Epstein F.
        Intraspinal tumors in children and infants.
        in: Youmans J.R. Becker D.P. Dunsker S.B. Neurological surgery. 4th ed. W.B. Saunders Co., Philadelphia1996: 3123-3133
        • Cooper P.R.
        Outcome after operative treatment of intramedullary spinal cord tumors in adults: intermediate and long-term results in 51 patients.
        Neurosurgery. 1989; 25: 855-859
        • DeSousa A.L.
        • Kalsbeck J.E.
        • Mealey J.
        • et al.
        Intraspinal tumors in children: a review of 81 cases.
        J Neurosurg. 1979; 51: 437-445
        • Maira G.
        • Amante P.
        • Denaro L.
        • et al.
        Surgical treatment of cervical intramedullary spinal cord tumors.
        Neurol Res. 2001; 23: 835-842
        • Miller D.C.
        Surgical pathology of intramedullary spinal cord neoplasm.
        J Neurooncol. 2000; 47: 189-194
        • McCormick P.C.
        • Stein B.M.
        Intramedullary tumors in adults.
        Neurosurg Clin N Am. 1990; 1: 609-630
        • Narayan P.
        • Barrow D.L.
        Intramedullary spinal cavernous malformation following spinal irradiation.
        J Neurosurg. 2003; 98: 68-72
        • Schwartz T.H.
        • McCormick P.C.
        Intramedullary ependymomas: clinical presentation, surgical treatment strategies and prognosis.
        J Neurooncol. 2000; 47: 211-218
        • Lonser R.R.
        • Weil R.J.
        • Wanebo J.E.
        • et al.
        Surgical management of spinal cord hemangioblastomas in patients with von Hippel-Lindau disease.
        J Neurosurg. 2003; 98: 106-116
        • Neumann H.P.
        • Eggert H.R.
        • Weigel K.
        • et al.
        Hemangioblastomas of the CNS: a 10-year study with special reference to von Hippel-Lindau syndrome.
        J Neurosurg. 1989; 70: 24-30
        • Pluta R.M.
        • Iuliano B.
        • DeVroom H.L.
        • et al.
        Comparison of anterior and posterior surgical approaches in the treatment of ventral spinal hemangioblastomas in patients with von Hippel-Lindau disease.
        J Neurosurg. 2003; 98: 117-124
        • Solomon R.A.
        • Stein B.M.
        Unusual spinal cord enlargement related to intramedullary hemangioblastoma.
        J Neurosurg. 1988; 68: 550-553
        • Chang U.K.
        • Choe W.J.
        • Chung S.K.
        • et al.
        Surgical outcome and prognostic factors of spinal intramedullary ependymomas in adults.
        J Neurooncol. 2002; 57: 133-139
        • Ferrante L.
        • Mastronardi L.
        • Celli P.
        • et al.
        Intramedullary spinal cord ependymomas: a study of 45 cases with long term follow-up.
        Acta Neurochir (Wien). 1992; 119: 74-79
        • Kane P.J.
        • El-Mahdy W.
        • Singh A.
        • et al.
        Spinal intradural tumours: part II—intramedullary.
        Br J Neurosurg. 1999; 13: 558-563
        • Constantini S.
        • Miller D.C.
        • Allen J.C.
        • et al.
        Radical excision of intramedullary spinal cord tumors: surgical morbidity and long term follow-up evaluation in 164 children and young adults.
        J Neurosurg. 2000; 93: 183-193
        • Epstein F.J.
        • Farmer J.P.
        Pediatric spinal cord tumor surgery.
        Neurosurg Clin N Am. 1990; 1: 569-590
      1. Fischer G. Brotchi J. Intramedullary spinal cord tumors. Georg Thieme, New York1996
        • Guidetti B.
        • Mercuri S.
        • Vagnozzi R.
        Long-term results of the surgical treatment of 129 intramedullary spinal gliomas.
        J Neurosurg. 1981; 54: 323-330
        • Houten J.K.
        • Cooper P.R.
        Spinal cord astrocytomas: presentation, management and outcome.
        J Neurooncol. 2000; 47: 219-224
        • Innocenzi G.
        • Raco A.
        • Cantore G.
        • et al.
        Intramedullary astrocytomas and ependymomas in the pediatric age group: a retrospective study.
        Childs Nerv Syst. 1996; 12: 776-780
        • Cushing H.
        The special field of neurological surgery.
        Bull Johns Hopkins Hosp. 1905; 16: 77-87
        • Elsberg C.A.
        Tumors of the spinal cord and the symptoms of irritation and compression of the spinal cord and nerve roots.
        in: Pathology, Symptomatology, Diagnosis and Treatment. vol. I. Paul B. Hoeber, Inc., New York1925: 421
        • Elsberg C.A.
        • Beer E.
        The operability of intramedullary tumors of the spinal cord: a report of two operations with remarks upon the extrusion of intraspinal tumors.
        Am J Med Sci. 1911; 142: 636-647
        • Von Eiselberg A.F.
        • Ranzi E.
        Ueber die chirurgiche Behandlung der Hirn- und Ruckenmarkstumoren.
        Arch Klin Chir. 1913; 102: 309-468
        • Greenwood J.
        Intramedullary tumors of spinal cord: a follow-up study after total surgical removal.
        J Neurosurg. 1963; 20: 665-668
        • McCormick P.C.
        • Post K.D.
        • Stein B.M.
        Intramedullary tumours in adults.
        Neurosurg Clin N Am. 1990; 1: 591-608
        • Epstein F.J.
        The Cavitron ultrasonic aspirator in tumor surgery.
        Clin Neurosurg. 1983; 31: 497-505
        • Chandy M.J.
        • Babu S.
        Management of intramedullary spinal cord tumors: review of 68 patients.
        Neurol India. 1999; 47: 224-228
        • McCormick P.C.
        • Torres R.
        • Post K.D.
        • et al.
        Intramedullary ependymoma of the spinal cord.
        J Neurosurg. 1990; 72: 523-532
        • Klekamp J.
        • Samii M.
        Introduction of a score system for the clinical evaluation of patients with spinal processes.
        Acta Neurochir. 1993; 123: 221-223
        • Cooper P.R.
        • Epstein F.
        Radical resection of intramedullary spinal cord tumours in adults. Recent experience in 29 patients.
        J Neurosurg. 1985; 63: 492-499
        • Constantini S.
        • Houten J.
        • Miller D.C.
        • et al.
        Intramedullary spinal cord tumors in children under the age of 3 years.
        J Neurosurg. 1996; 85: 1036-1043
        • Cristante L.
        • Herrmann H.D.
        Surgical management of intramedullary spinal cord tumors: funcional outcome and sources of morbity.
        Neurosurgery. 1994; 35: 69-76
        • Brotchi J.
        • Noterman J.
        • Baleriaux D.
        Surgery of intramedullary spinal cord tumours.
        Acta Neurochir (Wien). 1992; 116: 176-178
        • Samii M.
        • Klekamp J.
        Surgical results of 100 intramedullary tumors in relation to accompanying syringomyelia.
        Neurosurgery. 1994; 35: 865-873
        • Epstein F.J.
        • Farmer J.P.
        • Freed D.
        Adult intramedullary spinal cord ependymomas: the results of surgery in 38 patients.
        J Neurosurg. 1993; 79: 204-209
        • Epstein F.
        • Epstein N.
        Surgical treatment of spinal cord astrocytomas of childhood: a series of 19 patients.
        J Neurosurg. 1982; 57: 685-689
        • Goh K.Y.
        • Velasquez L.
        • Epstein F.J.
        Pediatric intramedullary spinal cord tumors: is surgery alone enough?.
        Pediatr Neurosurg. 1997; 27: 34-39
        • Kumar R.
        • Singh V.
        Intramedullary mass lesion of the spinal cord in children of a developing milieu.
        Pediatr Neurosurg. 2004; 40: 16-22
        • Steinbok P.
        • Cochrane D.D.
        • Poskitt K.
        Intramedullary spinal cord tumors in children.
        Neurosurg Clin N Am. 1992; 3: 931-945
        • Cooper P.R.
        Outcome after operative treatment of intramedullary spinal cord tumors in adults: intermediate and long-term results in 51 patients.
        Neurosurgery. 1989; 25: 855-859
        • Garrido E.
        • Stein B.M.
        Microsurgical removal of intramedullary spinal cord tumors.
        Surg Neurol. 1977; 7: 215-219
        • Brotchi J.
        • Dewitte O.
        • Levivier M.
        • et al.
        A survey of 65 tumors within the spinal cord: surgical results and the importance of preoperative magnetic resonance imaging.
        Neurosurgery. 1991; 29 ([discussion: 656–7]): 651-656
        • Xu Q.W.
        • Bao W.M.
        • Mao R.L.
        • et al.
        Aggressive surgery for intramedullary tumor of cervical spinal cord.
        Surg Neurol. 1996; 46: 322-328
        • Minehan K.J.
        • Shaw E.G.
        • Scheithauer B.W.
        • et al.
        Spinal cord astrocytoma: pathological and treatment considerations.
        J Neurosurg. 1995; 83: 590-595
        • Sandler H.M.
        • Papadopoulos S.M.
        • Thornton Jr., A.F.
        • et al.
        Spinal cord astrocytoma: results of therapy.
        Neurosurgery. 1992; 30: 490-493
        • Whitaker S.J.
        • Bessell E.M.
        • Ashley S.E.
        • et al.
        Postoperative radiotherapy in the management of spinal cord ependymoma.
        J Neurosurg. 1991; 74: 720-728