title: Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients.
abstract: BACKGROUND
  Surgical outcomes for intramedullary spinal cord tumors are affected by many variables including tumor histology and preoperative neurological function.
  
  
  OBJECTIVE
  To analyze the impact of tumor histology on neurological outcome in primary intramedullary spinal cord tumors.
  
  
  METHODS
  A retrospective review of 102 consecutive patients with intramedullary spinal cord tumors treated at a single institution between January 1998 and March 2009.
  
  
  RESULTS
  Ependymomas were the most common tumors with 55 (53.9%), followed by 21 astrocytomas (20.6%), 12 hemangioblastomas (11.8%), and 14 miscellaneous tumors (13.7%). Gross total resection was achieved in 50 ependymomas (90.9%), 3 astrocytomas (14.3%), 11 hemangioblastomas (91.7%), and 12 miscellaneous tumors (85.7%). At a mean follow-up of 41.8 months (range, 1-132 months), we observed recurrences in 4 ependymoma cases (7.3%), 10 astrocytoma cases (47.6%), 1 miscellaneous tumor case (7.1%), and no recurrence in hemangioblastoma cases. When analyzed by tumor location, there was no difference in neurological outcomes (P = .66). At the time of their last follow-up visit, 11 patients (20%) with an ependymoma improved, 38 (69%) remained the same, and 6 (10.9%) worsened. In patients with an astrocytoma, 1 (4.8%) improved, 10 (47.6%) remained the same, and 10 (47.6%) worsened. One patient (8.3%) with a hemangioblastoma improved and 11 (91.7%) remained the same. No patient with a hemangioblastoma worsened. In the miscellaneous tumor group, 2 (14.3%) improved, 10 (71.4%) remained the same, and 2 (14.3%) worsened. Preoperative neurological status (P = .02), tumor histology (P = .005), and extent of resection (P < .0001) were all predictive of functional neurological outcomes.
  
  
  CONCLUSIONS
  Tumor histology is the most important predictor of neurological outcome after surgical resection because it predicts resectability and recurrence.
authors.affiliation: *Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; †Rho Inc., Chapel Hill, North Carolina.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
authors.forename: Shahid M
authors.initials: SM
authors.lastname: Nimjee
authors.forename: Tiffany R
authors.initials: TR
authors.lastname: Hodges
authors.forename: Erin
authors.initials: E
authors.lastname: Cutrell
authors.forename: Betsy D
authors.initials: BD
authors.lastname: Hughes
authors.forename: Ciaran J
authors.initials: CJ
authors.lastname: Powers
authors.forename: Ankit I
authors.initials: AI
authors.lastname: Mehta
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hardin
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
authors.forename: Robert E
authors.initials: RE
authors.lastname: Isaacs
authors.forename: Michael M
authors.initials: MM
authors.lastname: Haglund
authors.forename: Allan H
authors.initials: AH
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000473:pathology / Q000601:surgery*; D002574:Cervical Vertebrae; D002648:Child; D002675:Child, Preschool; D004806:Ependymoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018325:Hemangioblastoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000473:pathology* / Q000601:surgery*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D055815:Young Adult