Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases.
OBJECTIVE
To review a series of patients who underwent surgical removal of intramedullary spinal cord tumors, focusing on the long-term functional outcome, recurrence rates for the various tumors, and technical problems continually debated in neurosurgical practice.


METHODS
From December 1972 to June 2003, 202 patients underwent removal of intramedullary tumors. Lesions were located in the cervical spinal cord in 61 patients (30%), at a dorsal site in 60 (29%), at a cervicodorsal site in 51 (25%), and in the medullary cone in 30 (15%). The most frequent histological tumor types were astrocytomas (86 patients, 42%) and ependymomas (68 patients, 34%).


RESULTS
Of the 68 ependymomas, 55 (81%) were completely removed and 13 (19%) incompletely removed. In 66% of the patients (42 patients), the presenting signs and symptoms remained unchanged at long-term follow-up; in 25% (16 patients), they improved; and in 9% (6 patients), the clinical status worsened. Of the 27 Grade I astrocytomas, 22 (81%) were completely removed and 5 (19%) incompletely removed. Functional assessment of the 23 patients available at "late" follow-up showed that 26% (6 of 23 patients) had improved, 9% (2 of 23 patients) had worsened, and 66% (15 of 23 patients) remained unchanged from preoperative status. Conversely, of the 41 Grade II astrocytomas, only 5 (12%) were completely removed, and 10% had improved. None of the 18 Grade III to IV astrocytomas could be completely removed. In 61% (11 of 18 patients), the postoperative functional status worsened.


CONCLUSIONS
Determinant predictors of a good outcome after surgery for intramedullary spinal cord tumors are histological type of lesion, complete removal of the lesion, and a satisfactory neurological status before surgery.
Raco
Antonino
A
Department of Neurosurgery, University of Rome La Sapienza, Rome, Italy. racoant@tin.it
Esposito
Vincenzo
V
Lenzi
Jacopo
J
Piccirilli
Manolo
M
Delfini
Roberto
R
Cantore
Giampaolo
G
D001254:Astrocytoma / Q000601:surgery; D001932:Brain Neoplasms / Q000601:surgery; D020295:Brain Stem Neoplasms / Q000601:surgery*; D004806:Ependymoma / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome