title: Surgical Outcomes of High-Grade Spinal Cord Gliomas.
abstract: METHODS
  A retrospective study.
  
  
  OBJECTIVE
  The purpose of this study was to obtain useful information for establishing the guidelines for treating high-grade spinal cord gliomas.
  
  
  BACKGROUND
  The optimal management of high-grade spinal cord gliomas remains controversial. We report the outcomes of the surgical management of 14 high-grade spinal glioma.
  
  
  METHODS
  We analyzed the outcomes of 14 patients with high-grade spinal cord gliomas who were surgically treated between 1989 and 2012. Survival was charted with the Kaplan-Meier plots and comparisons were made with the log-rank test.
  
  
  RESULTS
  None of the patients with high-grade spinal cord gliomas underwent total resection. Subtotal resection was performed in two patients, partial resection was performed in nine patients, and open biopsy was performed in three patients. All patients underwent postoperative radiotherapy and six patients further underwent radiation cordotomy. The median survival time for patients with high-grade spinal cord gliomas was 15 months, with a 5-year survival rate of 22.2%. The median survival time for patients with World Health Organization grade III tumors was 25.5 months, whereas the median survival time for patients with glioblastoma multiforme was 12.5 months. Both univariate and multivariate Cox proportional hazards models demonstrated a significant effect only in the group that did not include cervical cord lesion as a factor associated with survival (p=0.04 and 0.03).
  
  
  CONCLUSIONS
  The surgical outcome of patients diagnosed with high-grade spinal cord gliomas remains poor. Notably, only the model which excluded cervical cord lesions as a factor significantly predicted survival.
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Seki
authors.affiliation: Sapporo Azabu Neurosurgical Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Hida
authors.affiliation: Sapporo Azabu Neurosurgical Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Syunsuke
authors.initials: S
authors.lastname: Yano
authors.affiliation: Department of Orthopedic Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aoyama
authors.affiliation: Hokkaido Neurosurgical Memorial Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Koyanagi
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
keywords: Glioma; Intramedullary tumor; Outcome; Radiation therapy; Spinal cord