[Intramedullary tumors. Results of a national investigation in private neurosurgery].
The frequency of intramedullary tumors is 0.5 cases per year for 100,000 inhabitants. The study reported herein was a retrospective study conducted from January 1985 to September 2007.


METHODS
Seventy-nine cases were distributed in the following manner: ependymomas, 38; astrocytomas, 22; oligodendrogliomas, four; gangliogliomas, two; hemangioblastomas, 10 (nine sporadic cases and one case of Von Hippel-Lindau disease); primitive melanoma, one; and intramedullary neurinomas, two. Three patients were lost to follow-up and 10 patients died.


METHODS
All patients were explored using MRI and were operated using a microsurgical technique. Tumor removal was complete in the cases of ependymoma and hemangioblastoma and subtotal in the cases of astrocytoma.


RESULTS
Ependymoma: 38 cases with three cases of ependymoblastoma. Mean age: 47 years (range, 17-74 years); 17 males and 21 females. Diagnostic delay: less than one year, 11; one year, 15 cases; two years, nine cases; three years, three cases. Seven recurrences with one 35 years after a prior removal. Localizations: cervical and cervicodorsal, 19; dorsal, ten; dorsolumbar, seven; holomedullary, one. Number of levels concerned: 5-12 (with the cysts associated). Mean follow-up was 10 years (range, two months to 35 years). Patients stabilized, 19; worse, six; improved, nine. Patients deceased: four, one by suicide, three cases of ependymoblastoma (survival, seven months). Astrocytomas: 22 cases, with 14 cases of astrocytoma, two pilocytic astrocytoma, four malignant astrocytoma, and two glioblastoma. Mean age: 44 years (range, 22-73 years); 14 males and eight females. Diagnostic delay: malignant tumors, one to nine months; low grades; three to six years (range, eight months to 25 years). Number of levels concerned: two to eight. Mean follow-up: seven years (range, six months to 10 years). Stabilized patients: 13; worse, five; deaths, four. Oligodendroglioma: four cases. Mean age: 58 years; two males and two females. Diagnostic delay: 10months. Localization: cervical, three; dorsal, one. Oligodendroglioma A, two; B, two. Results: two cases stabilized, one case with recurrence, and one patient deceased. Ganglioglioma: two. Both cases were associated with scoliosis. Recurrence in the eighth month and two years for the second case. One patient died. Hemangioblastoma: 10 cases, nine sporadic and one case of Von Hippel-Lindau disease. Nine cervical localizations, one on the medulla cone. Mean age: 45 years (range, 11-54 years); eight males and two females. Total removal in nine cases. One case of recurrence seven years after a prior surgery and operated a second time with no recurrence after 10 years of follow-up. Intramedullary neurinomas: two cases with a total removal and 15 years of follow-up. Primitive melanoma: one case with mediothoracic location. Treatment with surgery plus radiotherapy. Follow-up, seven years without recurrence.


CONCLUSIONS
Total removal of the intramedullary tumors is a challenge. In cases of removal, the risk of worsening status is 18-19.5%. Subtotal or incomplete removal 27-40% risk of recurrence.
Adam
Y
Y
Clinique Saint-Martin, 14050 Caen, France.
Benezech
J
J
Blanquet
A
A
Fuentes
J-M
JM
Bousigue
J-Y
JY
Debono
B
B
Duplessis
E
E
Espagno
C
C
Plas
J-Y
JY
Lescure
J-P
JP
Destandau
J
J
Hladky
J-P
JP
Grunewald
P
P
Mahla
K
K
Remond
J
J
Louis
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D020295:Brain Stem Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures; D016896:Treatment Outcome; D055815:Young Adult