Cordotomy for patients with thoracic malignant astrocytoma

Clinical article

Masaya NakamuraDepartment of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan

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Osahiko TsujiDepartment of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan

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Kanehiro FujiyoshiDepartment of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan

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Kota WatanabeDepartment of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan

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Takashi TsujiDepartment of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan

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Ken IshiiDepartment of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan

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Morio MatsumotoDepartment of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan

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Yoshiaki ToyamaDepartment of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan

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Kazuhiro ChibaDepartment of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan

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Object

The optimal management of malignant astrocytomas remains controversial, and the prognosis of these lesions has been dismal regardless of the administered treatment. In this study the authors investigated the surgical outcomes of cordotomy in patients with thoracic malignant astrocytomas to determine the effectiveness of this procedure.

Methods

Cordotomy was performed in 5 patients with glioblastoma multiforme (GBM) and 2 with anaplastic astrocytoma (AA). A Kaplan-Meier survival analysis was performed, and the associations of the resection level with survival and postoperative complications were retrospectively examined.

Results

Cordotomy was performed in a single stage in 2 patients with GBM and in 2 stages in 3 patients with GBM and 2 patients with AA. In the 2 patients with GBM, cordotomy was performed 2 and 3 weeks after a partial tumor resection. In the 2 patients with AA, the initial treatment consisted of partial tumor resection and subtotal resection combined with radiotherapy, and rostral tumor growth and progressive paralysis necessitated cordotomy 2 and 28 months later. One patient with a secondary GBM underwent cordotomy; the GBM developed 1 year after subtotal resection and radiotherapy for a WHO Grade II astrocytoma. Four patients died 4, 5, 24, and 42 months after the initial operation due to CSF dissemination, and 3 patients (2 with GBM and 1 with AA) remain alive (16, 39, and 71 months). No metastasis to any other organs was noted.

Conclusions

One-stage cordotomy should be indicated for patients with thoracic GBM or AA presenting with complete paraplegia preoperatively. In patients with thoracic GBM, even if paralysis is incomplete, cordotomy should be performed before the tumor disseminates through the CSF. Radical resection should be attempted in patients with AA and incomplete paralysis. If the tumor persists, radiotherapy and chemotherapy are indicated, and cordotomy should be reserved for lesions growing progressively after such second-line treatments.

Abbreviations used in this paper:

AA = anaplastic astrocytoma; GBM = glioblastoma multiforme.
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