title: Recurrence rates and functional outcome after resection of intrinsic intramedullary tumors.
abstract: BACKGROUND
  Intramedullary tumors account for 2-4% of all CNS neoplasms. Surgical resection is challenging because of aggravated neurological impairment in up to 64% of patients. We analyzed a consecutive series of patients with intramedullary tumors and focused on the extent of resection, functional outcome, and tumor recurrence.
  
  
  METHODS
  53 patients (23 women and 30 men; mean age 46.3 years) were included who had undergone microsurgical resection for intramedullary spinal tumors. We reviewed the patient records for tumor size, edema, intratumoral hemorrhage, consistency, midline detection, resection method, extent of resection, histopathology, and recurrence. Outcome was measured by the Karnofsky Score (KPI), the McCormick score (MCS), and the Medical Research Council Neurological Performance Score (MRC-NPS).
  
  
  RESULTS
  The most frequent diagnosis was ependymoma (37.7%), lymphoma (13.2%) and astrocytoma (11.3%). The majority of tumors were located in the thoracic spine (62.2%). Gross total resection was achieved in 73.6% and most successful in patients with ependymal histology (p<0.01). Tumor recurrence - observed in 11.3% - was significantly associated with age >65 years, astrocytic histology, higher tumor grades, and higher Ki-67 labeling. At follow-up, MCS and MRC-NPS showed significantly better results than prior to resection (p<0.001), and pain and sensory deficits had improved in 67.9% and 64.2% of patients, respectively. Microsurgical resection improved the neurological status significantly. Pain and sensory deficits showed higher improvement rates than paresis and vegetative dysfunction.
  
  
  CONCLUSIONS
  Our data help identify patients at risk of tumor recurrence and classify the course of postoperative neurological performance.
authors.affiliation: Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany; Wilhelm Sander-Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany. Electronic address: karl-michael.schebesch@ukr.de.
authors.forename: Karl-Michael
authors.initials: KM
authors.lastname: Schebesch
authors.affiliation: Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany; Wilhelm Sander-Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany. Electronic address: naphets2003@web.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Mueller
authors.affiliation: Department of Radiology, Regensburg University Hospital, Regensburg, Germany; Wilhelm Sander-Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany. Electronic address: christina.wendl@ukr.de.
authors.forename: Christina
authors.initials: C
authors.lastname: Wendl
authors.affiliation: Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany; Wilhelm Sander-Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany. Electronic address: alexander.brawanski@ukr.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Brawanski
authors.affiliation: Department of Neuropathology, Regensburg University Hospital, Regensburg, Germany; Wilhelm Sander-Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany. Electronic address: markus.riemenschneider@ukr.de.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Riemenschneider
authors.affiliation: Department of Neurosurgery, Regensburg University Hospital, Regensburg, Germany; Wilhelm Sander-Neuro-Oncology Unit, University Medical Center Regensburg, Regensburg, Germany. Electronic address: martin-proescholdt@ukr.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Proescholdt
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001254:Astrocytoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004806:Ependymoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D018325:Hemangioblastoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D006391:Hemangioma / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D017567:Karnofsky Performance Status; D019394:Ki-67 Antigen / Q000378:metabolism; D008223:Lymphoma / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008297:Male; D008579:Meningioma / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D008866:Microsurgery; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D018242:Neuroectodermal Tumors, Primitive / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D013120:Spinal Cord Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D019394:Ki-67 Antigen
keywords: Intramedullary tumors; McCormick scale; Medical Research Council Neurological Performance Score; Spinal tumors