Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults

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Object. The majority of intramedullary spinal cord tumors (IMSCT) in children and young adults are low-grade gliomas. Radical resection of similar tumors in the cerebral hemisphere or cerebellum is usually curative; however, the conventional management for IMSCTs remains partial resection followed by radiotherapy because of the concern for surgical morbidity. Nevertheless, radical resection of IMSCTs without routine adjuvant treatment has been the rule at our institution since 1980. In an attempt to resolve this controversy, the long-term morbidity and survival in a large series of children have been retrospectively reviewed.

Methods. The database records and current status of 164 patients 21 years of age and younger in whom an IMSCT was resected were reviewed. A gross-total resection (> 95%) was achieved in 76.8% of the surgical procedures. Subtotal resections (80–95%) were performed in 20.1%. The majority of patients (79.3%) had histologically low-grade lesions.

There were no deaths due to surgery. When comparing the preoperative and 3-month postoperative functional grades, 60.4% stayed the same, 15.8% improved, and 23.8% deteriorated. Only 13 patients deteriorated by more than one functional grade. Patients with either no deficits or only mild deficits before surgery were rarely injured by the procedure, reinforcing the importance of early diagnosis and treatment.

The major determinant of long-term patient survival was histological composition of the tumor. The 5-year progression-free survival rate was 78% for patients with low-grade gliomas and 30% for those with high-grade gliomas. Patients in whom an IMSCT was only partially resected (< 80%) fared significantly worse.

Conclusions. The long-term survival and quality of life for patients with low-grade gliomas treated by radical resection alone is comparable or superior to minimal resection and radiotherapy. The optimum therapy for patients with high-grade gliomas is yet to be determined.

Article Information

Address reprint requests to: Shlomi Constantini, M.D., M.Sc., Division of Pediatric Neurosurgery, Tel-Aviv-Sourasky Medical Center, 6 Weizman Street, Tel-Aviv, Israel 64239. email: sconsts@netvision.net.il.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Graph showing Kaplan—Meier curves of survival and PFS for 155 patients with IMSCTs.

  • View in gallery

    Graph showing Kaplan—Meier curves of PFS stratified by histological composition of the tumor. See text for definition of groups.

  • View in gallery

    Graph showing differences in PFS within the group of patients with astrocytomas. GBM = glioblastoma multiforme.

  • View in gallery

    Graph showing the effects of the extent of resection on PFS.

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