title: Intramedullary spinal cord astrocytomas: the influence of localization and tumor extension on resectability and functional outcome.
abstract: BACKGROUND
  Intramedullary spinal cord tumors (IMSCT) are rare lesions, ependymomas and astrocytomas being the most common ones. Different studies have been published showing results of different treatment strategies as extensive/ limited surgery, biopsy and adjuvant radiation therapy with regard to functional outcome and survival. The present study was undertaken to analyse our series of surgically treated intramedullary astrocytomas in order to identify factors with impact on functional outcome and resectability.
  
  
  METHODS
  Over a period of 20 years, among 215 patients with IMSCT 22 patients with astrocytomas were identified and enrolled into this analysis. Demographic data, clinical symptoms, localization and extension of the tumor, resection rate as well as pre- and postoperative neurological status were obtained. Patients were followed-up clinically and by MRI.
  
  
  RESULTS
  Complete resection rate was higher in cervically located tumors (9 of 10) compared to non-cervical tumors (7 of 12). Tumor extension (1-3 segments vs. > 3 segments involved) did not influence on the resection rate. Cervical tumors showed a trend for better postoperative functional outcome than non-cervical lesions (3 of 10 cervical but 6 of 12 non-cervical tumors deteriorated postoperatively). In tumors extending more than 3 segments postoperative worsening was significantly increased.
  
  
  CONCLUSIONS
  The present study shows a better resectability and functional outcome for cervically located intramedullary astrocytomas. Tumors extending more than three segments deteriorated significantly. These findings may help for decision-making process and treatment of these tumors.
authors.affiliation: Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany. aardeshiri@aol.com
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Ardeshiri
authors.forename: Bixia
authors.initials: B
authors.lastname: Chen
authors.forename: Bernd-Otto
authors.initials: BO
authors.lastname: Hütter
authors.forename: Neriman
authors.initials: N
authors.lastname: Oezkan
authors.forename: Isabel
authors.initials: I
authors.lastname: Wanke
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
authors.forename: Ibrahim Erol
authors.initials: IE
authors.lastname: Sandalcioglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D001706:Biopsy / Q000379:methods; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D013120:Spinal Cord Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult