Surgical management of long intramedullary spinal cord tumors.
OBJECTIVE
Spinal cord tumors represent approximately 10-20% of primary central nervous system tumors. Only 20-30% of primary intradural tumors are intramedullary. The incidence of longitudinally extensive tumors involving the cervical, thoracic, and lumbar spine is very low (<1% of intramedullary lesions); hence, little literature exists on the management of this entity.


METHODS
We retrospectively reviewed all patients undergoing surgical resection of longitudinally extensive intramedullary spinal cord tumors involving the majority of the spinal cord between 1990 and 2002. Clinical, radiographic, operative, and outcome variables were retrospectively recorded and reported.


RESULTS
Thirteen patients (eight male, five female) were included in the study. Mean age was 15 years (range, 3-45) at the time of the initial resection. Gross total resection was achieved in eight cases and subtotal resection in five cases. Pathology revealed astrocytoma in six cases (two pilocytic, four grade II), gangliogliomas in four cases, oligodendroglioma in two cases (one anaplastic), and lipoma in one case. One (8%) patient died from progression of anaplastic oligodendroglioma, and two (15%) underwent reoperation for recurrent tumor (ganglioglioma, grade II astrocytoma). With a mean of 3.4 years (range, 1-12) after surgery, the modified McCormick score (MMS) had worsened in only two (15%) patients, improved in three (23%) patients, and remained stable in seven (54%) patients compared to preoperative MMS. Five (38%) patients required fusion for progressive spinal deformity.


CONCLUSIONS
Gross total resection of holocord and longitudinally extensive intramedullary spinal cord tumors can be achieved with preservation of long-term neurological function in many cases. Serial imaging is recommended to guide subsequent resection for tumor recurrence and stabilization of progressive spinal deformity.
Tobias
Michael E
ME
Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, NY, USA.
McGirt
Matthew J
MJ
Chaichana
Kaisorn L
KL
Goldstein
Ira M
IM
Kothbauer
Karl F
KF
Epstein
Fred
F
Jallo
George I
GI
D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D019635:Neurosurgical Procedures; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome