Surgical treatment of one hundred seventy-four intramedullary spinal cord tumors.

STUDY DESIGN: A retrospective study of microsurgical treatment of intramedullary spinal cord tumors (IMSCT) was conducted.

OBJECTIVE: In this article we review our experience in dealing with IMSCTs and try to answer the question of the optimum treatment of IMSCTs.

SUMMARY OF BACKGROUND DATA: IMSCTs are commonly seen tumors in intraspinal tumors. The optimum treatment of those tumors is controversial, with the recent advance, the operation of IMSCTs has became safer and total resection of most those tumor is possible.

METHODS: Data from 174 IMSCTs operated on in the last 20 years are analyzed retrospectively by the tumors' anatomic locations, histologic types, symptoms and signs, tumor removal rate, and operative outcomes.

RESULTS: In this group ependymoma was the commonest tumor (48.9%), the second most often seen being astrocytoma (35.6%). On admission 142 patients suffered from motor disturbance and 134 from dysaesthesia. Eighty-eight had sphincter disturbance and 100 spontaneous pain. Total resection of the tumor was possible in 60.9% of patients, subtotal resection in 17.2%, and partial resection in 13.8%. In patients with ependymoma total resection was possible in 92.9% of patients, subtotal in 5.95%, and partial resection in 1.2%. In low grade astrocytoma total resection was possible in 41.1%, subtotal in 35.1%, and partial resection in 23.2%. There were 6 patients with malignant astrocytomata; total resection was possible in 1 patient, subtotal resection in 2, and partial resection in 3.In the other tumors total resection was possible in 63% and subtotal in 14.8%, in 23.2% was partial resection possible. Six months after operation the patient's symptoms and signs were compared with those before operation. Neurologic deficits had improved in 60.4%, there was no change in 36.2% and deterioration in 3.4%. On long-term follow-up there was improvement in 70.2%, no change in 19.5%, deterioration in 4%, tumor recurrence in 6.9%, with 6.3% of patients dying.

CONCLUSION: Most intramedullary spinal cord tumors need operative treatment as early as possible. The outcome of aggressive surgery now is much better than it has been in the past, and the results are acceptable. For malignant tumors and those where total removal has not been possible radiation therapy is necessary.