title: Management and outcomes of intramedullary spinal cord tumors: A single center experience from a developing country.
abstract: BACKGROUND
  Intraoperative neurophysiology, high magnification microscopes, and ultrasonic aspirators are considered essential aid for the safe resection of intramedullary spinal cord tumors (IMSCTs). Most centers in developing countries such as Pakistan still lack these facilities. The purpose of this study was to review the management of IMSCTs at our hospital and to determine factors associated with the outcomes of surgery.
  
  
  METHODS
  This was a retrospective review of medical records of adult patients undergoing surgery for IMSCT over 12 years. The institutional ethical review committee approved this study. Data were collected regarding demographics, clinical and radiological features, and surgical details. Modified McCormick Scale was used to grade patients' neurological status at admission, discharge, and follow-up. Statistical analysis was performed using the Statistical Package for Social Sciences version 22.
  
  
  RESULTS
  Forty three cases were reviewed. Mean age was 33.8 ± 15.1 years whereas median follow-up was 5 months (range: 0.25-96 months). Most patients had ependymoma (n = 16; 73%). Cervical region was the most commonly involved (n = 15; 34.9%). Gross total resection (GTR) was achieved in 30 cases (69.8%). The preoperative McCormick grade was significantly associated with follow-up McCormick grade (P value = 0.002). Eight patients (18.6%) underwent intraoperative electrophysiological monitoring, out of which GTR was achieved in all cases, and none had disease progression or recurrence. Ten patients received postoperative radiotherapy. Thirty five patients (81.4%) had progression free survival at last follow-up.
  
  
  CONCLUSIONS
  We achieved a GTR rate of 68.9% for IMSCTs with limited resources. In few cases, where intraoperative electrophysiology was used, the rate of GTR was 100%. Preoperative neurological status was associated with better postoperative McCormick score.
authors.affiliation: Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Saqib K
authors.initials: SK
authors.lastname: Bakhshi
authors.affiliation: Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Waqas
authors.affiliation: Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Baila
authors.initials: B
authors.lastname: Shakaib
authors.affiliation: Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Enam
keywords: Intramedullary spinal cord tumor; modified McCormick scale; spinal cord