gms | German Medical Science

Objective: Intradural conus and cauda tumours are rare. Only few large clinical series exist so far.

Method: All intradural conus and cauda tumours treated surgically at our department between 03/2006-05/2012 were retrospectively consecutively evaluated. Arachnoid cysts and multifocal tumours were excluded. 68 adult patients were included (35 female, 33 male, median age 56 y.). Follow-up is available for 74% (n=49) with a median period of 9 months.

Results: 18 tumours were located intramedullary and 50 extramedullary. Histology: 27 nerve sheath tumours (25 WHO°I, 1 WHO°II, 1 WHO°IV) , 17 ependymomas (8 WHO°I, 8 WHO°II, 1 WHO°III), 9 meningeomas (7 WHO°I, 2 WHO°II), 4 carcinoma metastases, 3 cavernomas, 2 lipomas, 2 (epi-)dermoids, 2 paragangliomas, 1 astrocytoma (WHO°II), 1 haemangioblastoma. 6 patients were asymptomatic. The most common symptom was pain, followed by sensory and motor deficits, and conus/cauda syndrome. Gross total resection (GTR) was achieved in 88% (n=60) (subtotal resection n=4, debulking n=2, biopsies n=2). At discharge, 41% (n=28) improved, 41% (n=28) were unchanged, 18% (n=12) worsened. During the follow-up the majority recovered rendering 6% (n=4) deteriorated, 53% (n=36) improved including 29% (n=20) asymptomatic patients. Histological entities of ependymomas and carcinoma metastases were associated with unfavourable outcomes. Patients without preoperative neurological deficits were asymptomatic in follow-up more frequently than those with pre-existent disability. However, the rate of new postoperative impairment was not lower in patients without preoperative neurological deficits. All patients with intradural metastases died until the first follow-up examination (median survival=5 months). 4 patients had tumour recurrences (all WHO°I, 3 after GTR).

Conclusions: Conus and cauda tumours present a varied clinical and histological picture. Clinical manifestation is usually unspecific mimicking degenerative lumbar syndromes. Despite a significant risk of transient deterioration, early surgery is advisable since >94% keep at least the preoperative status and >50% improve during the follow-up.