gms | German Medical Science

Objective: The aim of this study is to evaluate influence of different clinical, surgical and histological factors on the functional results of the surgical treatment of intramedullary spinal cord tumors (IMSCTs).

Methods: A series of 38 patients operated on between September 1995 and October 2007 for IMSCT was retrospectively reviewed. There were 25 male and 13 female patients with a mean age of 47.4 yrs. Low grade astrocytomas and ependymomas were the two predominant tumors, corresponding to 60% of the complete series. Since 2004, motor evoked potentials (MEPs) were recorded with transcranial electrical stimulation and recording from limb muscles. Preoperative and postoperative functional status were defined according to Mc Cormick scale. In order to assess their prognostic functional significance, we investigated the following factors: age and sex; preoperative clinical conditions; extension of resection; intraoperative neurophysiological monitoring; histological type and grade.

Results: Despite the wide-spread use of modern neuroimaging techniques (MRI), only 14 pts (36.8%) were admitted in good clinical conditions (grade I and II of Mc Cormick scale); 15 (39.5%) were grade III and 9 (23.7%) grade IV. A radical resection was possible in all cases of ependymomas and in all cases of hemangioblastomas, subependymoma and teratomas. Two pilocytic atrocytomas were radically removed; in 9 infiltrating astrocytomas only a partial resection or biopsy was possible. This also applied to malignant astrocytomas and metastases.

First and second Mc Cormick scale patients at discharge and follow-up were only those affected by low grade tumors. No patients suffering from a malignant lesion was in good functional condition. In other words, there is a correlation between: low histological grade, radical surgical removal, good preoperative clinical condition, prolonged survival. The intraoperative monitoring of MEPs has also improved the functional results.

Conclusions: Almost all the elements considered in the present study are predictors of the functional outcome. A positive prognostic value is evident for low histological grade, functional preoperative status I and II and radical removal of the tumor.