title: Primary intramedullary tumors of the spinal cord.
abstract: METHODS
  Clinically based systematic review.
  
  
  OBJECTIVE
  To define optimal clinical care for primary intramedullary spinal cord tumors using a systematic review with expert opinion.
  
  
  METHODS
  Focused questions on the treatment of primary intramedullary spinal cord tumors were refined by a panel of spine oncology surgeons, medical and radiation oncologist. Keyword were searched through Medline database and pertinent abstracts and manuscripts obtained. The quality of literature was rated as high, moderate, low, or very low. Using the GRADE evidence based review system the proposed questions were answered using the literature review and expert opinion. These treatment recommendations were then rated as either strong or weak based on the quality of evidence and clinical expertise.
  
  
  RESULTS
  The literature searches revealed low and very low quality evidence with no prospective or randomized studies. The MEDLINE search engine returned 9000 articles which was restricted to articles about human subjects and written in the English language. The subsequent search resulted in a return of: "spinal cord tumor" (5053), "ependymoma" (580), "astrocytoma" (420), and "glioma" (235) articles. Seventeen articles referenced timing of surgical intervention and symptomatology for intramedullary spinal cord tumors. One hundred fifty-eight chemotherapy and 183 radiation therapy articles for intramedullary spinal cord tumors were reviewed.
  
  
  CONCLUSIONS
  The most important factor in determining the IMSCT patient's long-term neurologic and functional outcome after surgery is the patient's preoperative neurologic status. However, this must be taken in the context of the underlying tumor histology. Therefore, resection is reserved for progressive neurologic decline and serial monitoring for asymptomatic individuals. Adjuvant therapy is an option for high grade astrocytomas (WHO grades 3-4).
authors.affiliation: Department of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 1910, USA. james.harrop@jefferson.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Aruna
authors.initials: A
authors.lastname: Ganju
authors.forename: Michael
authors.initials: M
authors.lastname: Groff
authors.forename: Mark
authors.initials: M
authors.lastname: Bilsky
mesh_terms: D005910:Glioma / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D018714:Radiotherapy, Adjuvant; D012720:Severity of Illness Index; D013120:Spinal Cord Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome