gms | German Medical Science

Objective: Intradural spinal tumors (ISM) account for approx. 4% of CNS tumors in adults. Despite establishment of intraoperative neuromonitoring (IOM) in neurosurgical ORs, operative treatment is associated with up to 30–60% transient or permanent neurological deterioration. Here we present our operative experience during ten years in a large population. We focused on the correlation between extent of resection (EOR), recurrence rate and recovery of functional outcome.

Method: 71 patients with complete datasets were included in this retrospective analysis. The observational period was 2003–2013. The charts, pre- and postoperative imaging (MRI, CT) and the follow-up outpatient documentation were screened for EOR, style of resection (piece meal versus en bloc), procedural-related complications. These findings were correlated to histology, rate of recurrence and functional outcome according to Karnofsky Score (KS), McCormick Score (MCS) and Medical Research Council Neurological Performance Score (MRC-NPS) in uni- and multivariate analysis.

Results: Complete resection was achieved in 57 patients (80.3%), significantly associated with meningeal and ependymal histology (p<0.05). Most frequent histology was ependymoma (36.6%), meningeoma (11.3%) and astrocytoma (9.8%). The recurrence rate was 11.3%. Factors influencing the recurrence rate were age, astrocytic histology, grading and EOR. The KS remained stable during the observational period but the neurological performance significantly improved in 37.5%. Pain and sensory deficits showed the best results of improvement (>60%) while the lowest improvement rates were found for motor deficit and bladder dysfunction.

Conclusions: Microsurgical resection significantly improved the neurological performance in the long-term. Pain and sensory deficits recovered better than motor and vegetative disturbances. EOR, age, histology and grading significantly influenced the recurrence rate.