gms | German Medical Science

Objective: A retrospective analysis of the surgical treatment and outcome of 148 patients (93 adults, 55 children) with craniospinal lesions operated during the period 1990–2007 at our clinic was performed. The aim of the analysis was to assess the factors affecting radicality, operative accuracy, neuronavigational guidance and correction of instability and outcome.

Methods: The mean age was 45 years in adults and 5 years in children. The male to female ratio was 1:1,3. The most frequent neurological symptoms were intracranial hypertension, alternate syndromes, dyscoordination, hydrocephalus and cranial and spinal nerves palsy. We observed 6 patients with inflammatory lesions and 142 patients with tumors. In patients with tumors imaging revealed extradural tumors in 42 cases, intradural, extraaxial in 30 cases, intradural, intraaxial in 71 cases. In 79 patients the origin was cranial and 63 patients were with primary spinal origin. The most frequent histological types in adults were meningioma (24%), astrocytoma (21%), schwannoma (11%), metastasis (11%), chordoma (9%), ependymoma (8%) and in children: meduloblastoma (38%) and ependymoma (23%).

Results: We used suboccipital approach plus C1, C2 laminectomy in 137 operations.transoral and transsphenoidal approaches were employed in 40 cases, FLA in 10 cases. Neuronavigational guidance, which increased operative accuracy, was used in 11 cases. Complete lesion removal was achieved in 25% of the cases, partial and subtotal removal – in 64% and biopsy – in 11% of the cases. Because of craniocervical instability, we performed occipitocervical spondylodesis in 12 cases. The most common complications were: CSF leak (4%), postoperative haematomas (1,6%), brainstem oedema (1,6%), destabilization (0,8%), and pulmonary embolism (4,8%). The perioperative mortality was 4,8%. The 10 year follow-up showed good recovery in 32%, moderate disablement in 29%, severe disablement in 20%, vegetative status in 13% and death in 6%.

Conclusions: Neuronavigational guidance increases operative accuracy and it is advisable especially for transoral removal of craniospinal lesions. Despite improved surgical approaches, surgical techniques and neuro-intensive care the results of treatment are far from optimal.