Quality of life after surgical treatment of primary intramedullary spinal cord tumors in children

Clinical article

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  • 1 Divisions of Neurosurgery and
  • | 2 Pediatric Neurology, Cantonal Hospital of Lucerne; and
  • | 3 Department of Neurosurgery, University of Basel, Switzerland
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Object

Presently, the best available treatment for intramedullary spinal cord tumors (IMSCTs) in children is microsurgery with the objective of maximal tumor removal and minimal neurological morbidity. The latter has become manageable with the development and standard use of intraoperative neurophysiological monitoring. Traditionally, the perioperative neurological evaluation is based on surgical or spinal cord injury scores focusing on sensorimotor function. Little is known about the quality of life after such operations; therefore, this study was designed to investigate the impact of surgery for IMSCTs on the quality of life in children.

Methods

Twelve consecutive pediatric patients treated for IMSCT were included in this retrospective fixed cohort study. A multidimensional questionnaire-based quality of life instrument, the Pediatric Quality of Life Questionnaire version 4 (PedsQL 4.0), was chosen to analyze follow-up data. This validated instrument particularly allows for a comparison between a patient cohort and a healthy pediatric sample population.

Results

Of 11 mailed questionnaires (1 patient had died of progressive disease), 10 were returned, resulting in a response rate of 91%. There were 8 low-grade lesions (5 pilocytic astrocytomas, 1 ganglioglioma, 1 hemangioblastoma, and 1 cavernoma) and 4 high-grade lesions (2 anaplastic gangliogliomas, 1 glioblastoma, and 1 glioneuronal tumor). The mean age at diagnosis was 7.5 years, the mean follow-up was 4.2 years, and 83% of the patients were male. Total resection was achieved in 5 patients and subtotal resection in 7. Four patients had undergone 2 or more resections. The 4 patients with high-grade tumors and 2 with incompletely resected low-grade tumors underwent adjuvant treatment (2 chemotherapy and 4 both radiotherapy and chemotherapy). The mean modified McCormick Scale score at the time of diagnosis was 1.7; at the time of follow-up, 1.5. The mean PedsQL 4.0 total score in the low-grade group was 78.5; in the high-grade group, 82.6. There was no significant difference in PedsQL 4.0 scores between the patient cohort and the normal population.

Conclusions

In a small cohort of children who had undergone surgery for IMSCTs with a mean follow-up of 4.2 years, quality of life scores according to the PedsQL 4.0 instrument were not different from those in a normal sample population.

Abbreviations used in this paper:

CSR = Child Self Report; IMSCT = intramedullary spinal cord tumor; mMS = modified McCormick Scale; PedsQL 4.0 = Pediatric Quality of Life Questionnaire version 4.0; PPR = Parent Proxy Report; QOL = quality of life.

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  • 1

    Bansal S, , Ailawadhi P, , Suri A, , Kale SS, , Sarat Chandra P, & Singh M, et al.: Ten years' experience in the management of spinal intramedullary tumors in a single institution. J Clin Neurosci 20:292298, 2013

    • Search Google Scholar
    • Export Citation
  • 2

    Bansal S, , Suri A, , Borkar SA, , Kale SS, , Singh M, & Mahapatra AK: Management of intramedullary tumors in children: analysis of 82 operated cases. Childs Nerv Syst 28:20632069, 2012

    • Search Google Scholar
    • Export Citation
  • 3

    Benesch M, , Weber-Mzell D, , Gerber NU, , von Hoff K, , Deinlein F, & Krauss J, et al.: Ependymoma of the spinal cord in children and adolescents: a retrospective series from the HIT database. Clinical article. J Neurosurg Pediatr 6:137144, 2010

    • Search Google Scholar
    • Export Citation
  • 4

    Chan KS, , Mangione-Smith R, , Burwinkle TM, , Rosen M, & Varni JW: The PedsQL: reliability and validity of the short-form generic core scales and asthma module. Med Care 43:256265, 2005

    • Search Google Scholar
    • Export Citation
  • 5

    Choi GH, , Oh JK, , Kim TY, , You NK, , Lee HS, & Yoon DH, et al.: The clinical features and surgical outcomes of pediatric patients with primary spinal cord tumor. Childs Nerv Syst 28:897904, 2012

    • Search Google Scholar
    • Export Citation
  • 6

    Constantini S, , Houten J, , Miller DC, , Freed D, , Ozek MM, & Rorke LB, et al.: Intramedullary spinal cord tumors in children under the age of 3 years. J Neurosurg 85:10361043, 1996

    • Search Google Scholar
    • Export Citation
  • 7

    Constantini S, , Miller DC, , Allen JC, , Rorke LB, , Freed D, & Epstein FJ: Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg 93:2 Suppl 183193, 2000

    • Search Google Scholar
    • Export Citation
  • 8

    de Amoreira Gepp R, , Couto JM, , Silva MD, , Silva RT, & Neri EA: Intramedullary tumors in children: analysis of 24 operated cases. Arq Neuropsiquiatr 68:396399, 2010

    • Search Google Scholar
    • Export Citation
  • 9

    Felder-Puig R, , Frey E, , Proksch K, , Varni JW, , Gadner H, & Topf R: Validation of the German version of the Pediatric Quality of Life Inventory (PedsQL) in childhood cancer patients off treatment and children with epilepsy. Qual Life Res 13:223234, 2004

    • Search Google Scholar
    • Export Citation
  • 10

    González-Gil T, , Mendoza-Soto A, , Alonso-Lloret F, , Castro-Murga R, , Pose-Becerra C, & Martín-Arribas MC: The Spanish version of the health-related quality of life questionnaire for children and adolescents with heart disease (PedsQL™). Rev Esp Cardiol (Engl Ed) 65:249257, 2012

    • Search Google Scholar
    • Export Citation
  • 11

    Guss ZD, , Moningi S, , Jallo GI, , Cohen KJ, , Wharam MD, & Terezakis SA: Management of pediatric spinal cord astrocytomas: outcomes with adjuvant radiation. Int J Radiat Oncol Biol Phys 85:13071311, 2013

    • Search Google Scholar
    • Export Citation
  • 12

    Jallo GI, , Kothbauer KF, & Epstein FJ: Intrinsic spinal cord tumor resection. Neurosurgery 49:11241128, 2001

  • 13

    Katoh N, , Shirato H, , Aoyama H, , Onimaru R, , Suzuki K, & Hida K, et al.: Hypofractionated radiotherapy boost for dose escalation as a treatment option for high-grade spinal cord astrocytic tumor. J Neurooncol 78:6369, 2006

    • Search Google Scholar
    • Export Citation
  • 14

    Kothbauer KF, , Deletis V, & Epstein FJ: Motor-evoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in a series of 100 consecutive procedures. Neurosurg Focus 4:5 E1, 1998

    • Search Google Scholar
    • Export Citation
  • 15

    Lusić I, , Dzamonja G, , Titlić M, , Bilić I, , Sodić L, & Lusić L, et al.: Psychometric validation of the Croatian version of the Quality of Life in Epilepsy Inventory (QOLIE-31). Coll Antropol 35:11771184, 2011

    • Search Google Scholar
    • Export Citation
  • 16

    McCormick PC, & Stein BM: Intramedullary tumors in adults. Neurosurg Clin N Am 1:609630, 1990

  • 17

    McGirt MJ, , Chaichana KL, , Atiba A, , Attenello F, , Woodworth GF, & Jallo GI: Neurological outcome after resection of intramedullary spinal cord tumors in children. Childs Nerv Syst 24:9397, 2008

    • Search Google Scholar
    • Export Citation
  • 18

    McGirt MJ, , Chaichana KL, , Atiba A, , Attenello F, , Yao KC, & Jallo GI: Resection of intramedullary spinal cord tumors in children: assessment of long-term motor and sensory deficits. J Neurosurg Pediatr 1:6367, 2008

    • Search Google Scholar
    • Export Citation
  • 19

    McGirt MJ, , Chaichana KL, , Atiba A, , Bydon A, , Witham TF, & Yao KC, et al.: Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty. J Neurosurg Pediatr 1:5762, 2008

    • Search Google Scholar
    • Export Citation
  • 20

    Nadkarni TD, & Rekate HL: Pediatric intramedullary spinal cord tumors. Critical review of the literature. Childs Nerv Syst 15:1728, 1999

    • Search Google Scholar
    • Export Citation
  • 21

    Sala F, , Palandri G, , Basso E, , Lanteri P, , Deletis V, & Faccioli F, et al.: Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery 58:11291143, 2006

    • Search Google Scholar
    • Export Citation
  • 22

    Scheinemann K, , Bartels U, , Huang A, , Hawkins C, , Kulkarni AV, & Bouffet E, et al.: Survival and functional outcome of childhood spinal cord low-grade gliomas. Clinical article. J Neurosurg Pediatr 4:254261, 2009

    • Search Google Scholar
    • Export Citation
  • 23

    Schneider C, , Vosbeck J, , Grotzer MA, , Boltshauser E, & Kothbauer KF: Anaplastic ganglioglioma: a very rare intramedullary spinal cord tumor. Pediatr Neurosurg 48:4247, 2012

    • Search Google Scholar
    • Export Citation
  • 24

    Tendulkar RD, , Pai Panandiker AS, , Wu S, , Kun LE, , Broniscer A, & Sanford RA, et al.: Irradiation of pediatric high-grade spinal cord tumors. Int J Radiat Oncol Biol Phys 78:14511456, 2010

    • Search Google Scholar
    • Export Citation
  • 25

    Tobias ME, , McGirt MJ, , Chaichana KL, , Goldstein IM, , Kothbauer KF, & Epstein F, et al.: Surgical management of long intramedullary spinal cord tumors. Childs Nerv Syst 24:219223, 2008

    • Search Google Scholar
    • Export Citation
  • 26

    Varni JW, , Burwinkle TM, , Seid M, & Skarr D: The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr 3:329341, 2003

    • Search Google Scholar
    • Export Citation
  • 27

    Varni JW, & Limbers CA: The PedsQL 4.0 Generic Core Scales Young Adult Version: feasibility, reliability and validity in a university student population. J Health Psychol 14:611622, 2009

    • Search Google Scholar
    • Export Citation
  • 28

    Varni JW, , Limbers CA, , Neighbors K, , Schulz K, , Lieu JE, & Heffer RW, et al.: The PedsQL™ Infant Scales: feasibility, internal consistency reliability, and validity in healthy and ill infants. Qual Life Res 20:4555, 2011

    • Search Google Scholar
    • Export Citation
  • 29

    Varni JW, , Seid M, , Knight TS, , Uzark K, & Szer IS: The PedsQL 4.0 Generic Core Scales: sensitivity, responsiveness, and impact on clinical decision-making. J Behav Med 25:175193, 2002

    • Search Google Scholar
    • Export Citation
  • 30

    Varni JW, , Seid M, & Kurtin PS: PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care 39:800812, 2001

    • Search Google Scholar
    • Export Citation
  • 31

    Varni JW, , Seid M, & Rode CA: The PedsQL: measurement model for the pediatric quality of life inventory. Med Care 37:126139, 1999

  • 32

    Yao KC, , McGirt MJ, , Chaichana KL, , Constantini S, & Jallo GI: Risk factors for progressive spinal deformity following resection of intramedullary spinal cord tumors in children: an analysis of 161 consecutive cases. J Neurosurg 107:6 Suppl 463468, 2007

    • Search Google Scholar
    • Export Citation

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