[Intramedullary astrocytomas: A French retrospective multicenter study].
OBJECTIVE
The authors report the results of a multicenter retrospective series with a long-term follow-up and the analysis of clinical, radiological, surgical data as well as the complementary treatments in patients with intramedullary astrocytomas (IA).


METHODS
We performed a retrospective analysis of all the patients with IA operated on between 1984 and 2011 at 7 French centers (Kremlin-Bicêtre, Lille, Lyon, Marseille, Montpellier, Nice, and Nîmes). The minimum follow-up was 12 months. The clinical evaluation was based on the McCormick scale (MCS) results from the pre- and postoperative period.


RESULTS
Data from 95 patients with a pathologically confirmed diagnosis of IA were considered: 54 patients were treated at the Neurosurgical Department of Kremlin-Bicêtre Hospital, 8 were treated at Lille and 33 were treated in the south region of France. The epidemiological analysis was performed on the whole cohort of patients while follow-up considerations were made solely on the 54 patients managed at Kremlin-Bicêtre Hospital to obtain homogeneous data. The average age at diagnosis was 35.6 years without significant gender difference (47 % men for 53 % women). The age at first clinical manifestation was 33.7 years. The average duration of the symptoms before the diagnosis was 22.9 months. Neuropathic pain was the principal revealing symptom (76 % of cases). The localization of IA was thoracic in 40 %, purely cervical in 28.4 %. Complete removal was achieved in 29.5 % of cases when considering the whole cohort and in 38 % of cases treated at Bicêtre Hospital. The histological distribution recorded was: grade 1 in 35 %; grade 2 in 35 %; grade 3 in 22 % and grade 4 in 8 %. During the early postoperative period (3 months) a worsening of functional capacity was observed with an increase in the frequencies of ranks 3 and 4 of MCS in 18.4 %. At 5 years follow-up, the frequencies of ranks 1 and 2 were increased. The application of a Cox model for the determination of the relative risk of death for IA grade 1 and 2 (66 patients) showed a probability of survival at 5 years of 78.6 % (CI 95 %: 68.6 %-87.6 %). Survival at 10 years is to 76.8 % (CI 95 %: 62.3 %-84.2 %).


CONCLUSIONS
Surgery is indicated if the patient is symptomatic or the tumor increases in size. A radical excision remains the mainstay of treatment, while searching to preserve the motor function. A total resection was however only possible in 38 % of cases. A regular postoperative follow-up is compulsory and the adjuvant treatment is based on chemotherapy and radiotherapy according to the histological type.
Service de neurochirurgie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Sud, 78, rue du Général-Leclerc, 94275 Kremlin-Bicêtre cedex, France.
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F
Parker
Service de neurologie, CHU La Timone, 264, rue Saint-Pierre, 13385 Marseille, France.
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C
Campello
Service de neurochirurgie, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
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JP
Lejeune
Service de neurochirurgie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Sud, 78, rue du Général-Leclerc, 94275 Kremlin-Bicêtre cedex, France.
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P
David
Service de neurochirurgie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Sud, 78, rue du Général-Leclerc, 94275 Kremlin-Bicêtre cedex, France.
A
A
Herbrecht
Service de neurochirurgie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Sud, 78, rue du Général-Leclerc, 94275 Kremlin-Bicêtre cedex, France.
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N
Aghakhani
Service de neurochirurgie, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris, université Paris-Sud, 78, rue du Général-Leclerc, 94275 Kremlin-Bicêtre cedex, France. Electronic address: mahmoud.messerer@chuv.ch.
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M
Messerer
D000328:Adult; D001254:Astrocytoma / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000601:surgery
Astrocytomes intramédullaires; Histopathologie; Histopathology; Intramedullary astrocytoma; Microchirurgie; Microsurgery; Outcome; Resection rate; Résection; Spinal cord tumors; Tumeurs rachidiennes