gms | German Medical Science

Objective: Intrinsic tumors of the spinal cord are rare neoplasms that can leave patients neurologically and functionally devastated. In comparison to benign intramedullary spinal cord astrocytomas, the prognosis of malignant intramedullary astrocytomas has been poor with whatever treatment used.

Methods: We present a case of malignant glioma in a 27-year-old woman treated by spinal cordectomy. She was pretreated by surgery, radiation therapy and temozolomide chemotherapy and repeat surgery at recurrence. She then presented with progressive paraplegia and a diffuse severe pain syndrome. MRI displayed intraparenchymal invasion from T12 to T9. To assess tumor invasion intraoperatively, we used tumor fluorescence generated by 5-aminolevulinic acid (5-ALA).

The spinal cord was amputated caudally to the root entry zones of the T9 sensory roots. Additional cordectomy was performed because of tumor infiltration between the cut end and T9 as identified by intraoperative tumor fluorescence. The final transected level was between T8 and T9, and the cut end did not reveal any tumor invasion either intraoperatively by tumor fluorescence, or in the postoperative MRI, or with regard to the pathological result.

Results: After surgery, the patient was stable concerning spasticity, motor and sensory function, and showed complete relief of pain. The patient is recurrence-free 15 months after surgery.

Conclusions: This observation suggests that 5-ALA fluorescence-guided resections may be generally useful in the context of malignant spinal cord gliomas. Furthermore, our particular case indicates that palliative spinal cordectomy with a wide margin and intraoperative resection using fluorescence guidance may be a final option for patients with recurrent spinal malignant glioma presenting with complete deficit below the lesion.