title: Clinical presentation and outcome of patients with intradural spinal cord tumours.
abstract: We aimed to retrospectively investigate the clinical presentation and outcome of surgical intervention of patients with intradural spinal cord tumours (IDSCT), and to assess the predictors of surgical outcome. A total of 109 patients with IDSCT (57 males and 52 females) (130 admissions; mean age, 45.9 years; range, 14-89 years) underwent surgery between 1 January 1994 and 30 June 2009 at The Royal Melbourne Hospital. Ninety per cent of tumours were classified as low grade. Pain was the most common symptom at presentation (60%) and the mean duration of symptoms was 37.8 weeks (0-4 years). Total resection was achieved in 72.3% of patients with IDSCT. An extramedullary location was the strongest predictor of greater extent of tumour resection (odds ratio [OR]=4.367, 95% confidence interval [CI]=1.876-10.204, p=0.001), whereas a rostral location was also a significant predictor of greater resection (OR=1.393, 95% CI=1.014-1.908, p=0.040). The surgical mortality rate was 0.92%. A good pre-operative clinical grade was the strongest predictor of a positive post-operative neurological status at discharge for IDSCT (OR=7.382, 95% CI=4.575-11.912, p<0.001). The mean follow-up was 37.9 months (16 days-165 months). A good post-operative clinical grade was the most significant predictor of a positive neurological outcome at short-term follow-up (OR=9.953, 95% CI=4.941-20.051, p<0.001), while a good pre-morbid clinical grade was the most significant predictor of a positive outcome at long-term follow-up (OR=9.498, 95% CI=2.780-32.451, p<0.001). We concluded that surgical outcome was influenced by pre-morbid, pre-operative and post-operative clinical grades, the extent of resection, tumour grade and tumour location with respect to the spinal parenchyma. Surgical intervention has a high success rate for tumour control and we recommend total resection where possible.
authors.affiliation: Department of Surgery (RMH), The University of Melbourne, Parkville, Victoria 3050, Australia.
authors.forename: Mithun
authors.initials: M
authors.lastname: Nambiar
authors.forename: Bhadrakant
authors.initials: B
authors.lastname: Kavar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult