Surgical treatment of intramedullary spinal cord tumors: prognosis and complications.
METHODS
Retrospective case series.


OBJECTIVE
To evaluate our recent treatment strategy for intramedullary spinal cord tumors.


METHODS
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.
Nakamura
M
M
Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan. masa@sc.itc.keio.ac.jp
Ishii
K
K
Watanabe
K
K
Tsuji
T
T
Takaishi
H
H
Matsumoto
M
M
Toyama
Y
Y
Chiba
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002574:Cervical Vertebrae; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004806:Ependymoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D018325:Hemangioblastoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013904:Thoracic Vertebrae; D016896:Treatment Outcome