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Surgical treatment of intramedullary spinal cord tumors: prognosis and complications.
Spinal Cord. 2008 Apr; 46(4):282-6.SC

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.

Authors+Show Affiliations

Nakamura M
Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan. masa@sc.itc.keio.ac.jp
Ishii K
No affiliation info available
Watanabe K
No affiliation info available
Tsuji T
No affiliation info available
Takaishi H
No affiliation info available
Matsumoto M
No affiliation info available
Toyama Y
No affiliation info available
Chiba K
No affiliation info available

MeSH

AdolescentAdultAgedAstrocytomaCervical VertebraeChildChild, PreschoolCohort StudiesEpendymomaFemaleHemangioblastomaHumansMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesSpinal Cord NeoplasmsSurvival RateThoracic VertebraeTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17909556

Citation

Nakamura, M, et al. "Surgical Treatment of Intramedullary Spinal Cord Tumors: Prognosis and Complications." Spinal Cord, vol. 46, no. 4, 2008, pp. 282-6.
Nakamura M, Ishii K, Watanabe K, et al. Surgical treatment of intramedullary spinal cord tumors: prognosis and complications. Spinal Cord. 2008;46(4):282-6.
Nakamura, M., Ishii, K., Watanabe, K., Tsuji, T., Takaishi, H., Matsumoto, M., Toyama, Y., & Chiba, K. (2008). Surgical treatment of intramedullary spinal cord tumors: prognosis and complications. Spinal Cord, 46(4), 282-6.
Nakamura M, et al. Surgical Treatment of Intramedullary Spinal Cord Tumors: Prognosis and Complications. Spinal Cord. 2008;46(4):282-6. PubMed PMID: 17909556.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical treatment of intramedullary spinal cord tumors: prognosis and complications. AU - Nakamura,M, AU - Ishii,K, AU - Watanabe,K, AU - Tsuji,T, AU - Takaishi,H, AU - Matsumoto,M, AU - Toyama,Y, AU - Chiba,K, Y1 - 2007/10/02/ PY - 2007/10/3/pubmed PY - 2008/7/11/medline PY - 2007/10/3/entrez SP - 282 EP - 6 JF - Spinal cord JO - Spinal Cord VL - 46 IS - 4 N2 - 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. SN - 1362-4393 UR - https://www.unboundmedicine.com/medline/citation/17909556/Surgical_treatment_of_intramedullary_spinal_cord_tumors:_prognosis_and_complications_ L2 - https://doi.org/10.1038/sj.sc.3102130 DB - PRIME DP - Unbound Medicine ER -