gms | German Medical Science

Objective: Spinal tumors, especially intramedullary ones, are rare and considered to have a poor prognosis, unless they are radically removed. Technical progress has dramatically modified the strategy in management and outcome of patients with intramedullary tumors, allowing aggressive surgical approaches. On the basis of our experiences in the treatment of patients with cervical intramedullary tumors (CIT), the effectiveness of radical surgery will be reported.

Methods: The study consists of 37 patients with CIT, who were evaluated with respect to diagnostic procedures, surgical technique, intraoperative neurophysiologic monitoring (IOM) as well as postoperative outcome. Our patient study group had an average age of 38 years. The duration of symptoms was an average of 24 months preceding initial diagnosis. MRI was the most important diagnostic procedure and showed the exact location of the tumor within the spinal cord. After laminectomy or laminotomy, with preservation of the intervertebral joints, CO₂ or Nd-YAG laser was used for myelotomy and tumor dissection as well as removal. IOM with SEP and MEP was performed in all procedures.

Results: The histological findings included astrocytoma in 18 cases, ependymoma in 10 cases, cavernoma in 3 cases, angioblastoma in 3 cases, unknown histology in 2 cases and AVM in 1 case. A total removal of the lesion was achieved in 29 patients and a subtotal resection in 8 patients. At the time of discharge, 30% of the patients improved, 46% were unchanged and 24% had become neurologically worse. Surgical results estimated 6 months after surgery showed neurological improvement in 43%, stabilisation in 46% and deterioration in 11% of patients.

Conclusions: IOM, modern neurosurgical technique as well as experienced surgeons are important for the outcome. The tumor resection should be performed as soon as the diagnosis is made, because the other important factor influencing the outcome is the preoperative level of neurological deficits.