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58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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Surgical treatment of intramedullary tumors. Experience with 216 cases within the last 11 years

Chirurgische Behandlung intramedullärer Tumoren – Erfahrungen mit 216 Fällen

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  • corresponding author M. Leimert - Klinik für Neurochirurgie, Technische Universität Dresden, Deutschland
  • S. Sandi-Gahun - Klinik für Neurochirurgie, Technische Universität Dresden, Deutschland
  • J. Rautenberg - Klinik für Neurochirurgie, Technische Universität Dresden, Deutschland
  • S. Sobottka - Klinik für Neurochirurgie, Technische Universität Dresden, Deutschland
  • T. Pinzer - Klinik für Neurochirurgie, Technische Universität Dresden, Deutschland
  • D. Mucha - Abteilung für Neuroradiologie, Technische Universität Dresden, Deutschland
  • G. Schackert - Klinik für Neurochirurgie, Technische Universität Dresden, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.04.03

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc232.shtml

Published: April 11, 2007

© 2007 Leimert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Microsurgical excision of intramedullary tumors is one of the most challenging operations in spinal surgery. This is especially true for tumors, e.g. astrocytoma, without a clear cleavage between the tumor and normal spinal cord tissue. We report our experience on the surgical treatment of 216 patients with intramedullary tumors, focusing on long-term functional outcome, recurrence rates for various tumors und technical problems.

Methods: In retrospect we identified 216 patients. The most frequent tumor types were astrocytomas (113 patients), ependymomas (82 patients), cavernomas (13 patients) and angioblastomas (8 patients).

All patients had undergone preoperative magnetic resonance (MR) imaging. Surgery included laminectomy, laminoplasty, myelotomy, biopsy, duroplasty and CO2-laser. Postoperative long-term follow-up included clinical examinations and MRI scans of the spine.

Results: Of the 35 Grade I astrocytomas, 29 (83%) were completely removed and 6 (17%) incompletely removed. Of the 62 Grade II astrocytomas, 9 (15%) were completely removed and only 16% (10 of 62 patients) had improved in the functional assessment. None of the 16 Grade III to IV astrocytomas could be completely removed and in 63% (10 of 16 patients) the postoperative functional status deteriorated.

Of the 82 ependymomas, 70 (85%) were completely removed and 12 (15%) incompletely removed. The late follow-up is still continuing. Cavernomas and angioblastomas were resected completely, without any new neurological deficit.

Conclusions: Indications for surgery have been extended and changed, especially because of the improvement in surgical techniques and new therapeutic strategies. The histological type of lesion, complete removal of the lesion and a satisfactory neurological status before surgery are important predictors of a good outcome after surgery for intramedullary tumors.