doi:

DOI: 10.3724/SP.J.1008.2015.01304

Academic Journal of Second Military Medical University (第二军医大学学报) 2015/36:12 PP.1304-1308

Surgical treatment and prognostic factors of cervical intramedullary spinal cord tumors


Abstract:
Objective To summarize our experience in surgical treatment of cervical intramedullary spinal cord tumors and to identify the prognostic factors associated with postoperative neurological status. Methods The clinical data of 65 consecutive patients with cervical intramedullary spinal cord tumors undergoing operation between Jan. 2009 and Dec. 2013 were retrospectively reviewed. McCormick Scale was applied to evaluate the preoperative and postoperative neurological functions. Multivariate logistic regression analysis was used to determine the independent prognostic factors of postoperative neurological status. Results Laminectomy was performed in 61 patients and unilateral multilevel interlaminar fenestration (UMIF) was applied in 4 patients. Of all the 65 patients, 48 received total resection, 4 received subtotal resection and 13 received partial resection. The follow-up time was from 4 months to 15 years. The median follow-up time was 68 months. The clinical symptoms were relieved in 42 patients after operation, maintained unchanged in 14 and aggravated in 9. The pain remission rate of the patients was the highest (82.4%), followed by the sphincter dysfunction remission rate (68.8%), and the sensory disturbance remission rate of the patients was the lowest (39.6%). Based on McCormick Scale, the postoperative neurological functions was improved in 18 patients (27.7%) and maintained unchanged in 39 (60%), while eight patients (12.3%) developed neurological deterioration. Multivariate logistic regression analysis revealed that good preoperative neurological function (OR=19.87, 95% CI: 4.10-96.23, P =0.000)and total resection (OR=7.40, 95% CI: 1.34-40.95, P =0.022) were the independent protective factors for postoperative neurological status. Conclusion Microsurgical resection is the first-line treatment for cervical intramedullary spinal cord tumors, which can achieve a satisfying outcome in most cases. Preoperative neurological status and surgical extent are significantly associated with the postoperative functional outcome of patients.

Key words:spinal cord neoplasms;microsurgery;neurological function;prognosis

ReleaseDate:2016-05-27 09:20:00



[1] Brotchi J. Intrinsic spinal cord tumor resection[J]. Neurosurgery, 2002, 50: 1059-1063.

[2] Karikari I O, Nimjee S M, Hodges T R, Cutrell E, Hughes B D, Powers C J, et al. Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients[J]. Neurosurgery, 2011, 68: 188-197.

[3] Yang S, Yang X, Hong G. Surgical treatment of one hundred seventy-four intramedullary spinal cord tumors[J]. Spine (Phila Pa 1976), 2009, 34: 2705-2710.

[4] Sandalcioglu I E, Gasser T, Asgari S, Lazorisak A, Engelhorn T, Egelhof T, et al. Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients[J]. Spinal Cord, 2005, 43: 34-41.

[5] De Jonge T, Slullitel H, Dubousset J, Miladi L, Wicart P, Illes T. Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours[J]. Eur Spine J, 2005, 14: 765-771.

[6] Koch-Wiewrodt D, Wagner W, Perneczky A. Unilateral multilevel interlaminar fenestration instead of laminectomy or hemilaminectomy: an alternative surgical approach to intraspinal space-occupying lesions.Technical note[J]. J Neurosurg Spine, 2007, 6: 485-492.

[7] Xie T, Qian J, Lu Y, Jiang Y, Wan Z, Zhang L, et al.Unilateral multilevel interlaminar fenestration: a minimally invasive approach for cervical intramedullary lesions[J]. J Clin Neurosci, 2014, 21: 1196-1204.

[8] Fakhreddine M H, Mahajan A, Penas-Prado M, Weinberg J, McCutcheon I E, Puduvalli V, et al. Treatment, prognostic factors, and outcomes in spinal cord astrocytomas[J].Neuro Oncol, 2013, 15: 406-412.

[9] Li T Y, Chu J S, Xu Y L, Yang J, Wang J, Huang Y H, et al.Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients[J]. J Neurosurg Spine, 2014, 21: 249-259.

[10] Taricco M A, Guirado V M, Fontes R B, Plese J P. Surgical treatment of primary intramedullary spinal cord tumors in adult patients[J]. Arq Neuropsiquiatr, 2008, 66: 59-63.

[11] Berhouma M, Bahri K, Houissa S, Zemmel I, Khouja N, Aouidj L, et al. [Management of intramedullary spinal cord tumors: surgical considerations and results in 45 cases][J].Neurochirurgie, 2009, 55: 293-302.

[12] Bostrom A, von Lehe M, Hartmann W, Pietsch T, Feuss M, Bostrom J P, et al.Surgery for spinal cord ependymomas: outcome and prognostic factors[J]. Neurosurgery, 2011, 68: 302-308.