Article
Growth dynamics of intramedullary spinal tumors in patients suffering from Neurofibromatosis type 2
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Authors
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Anna Lawson McLean
- Medizinische Fakultät, Universitätsklinikum Jena
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Steffen Rosahl
- Klinik für Neurochirurgie, HELIOS Klinikum Erfurt
| Published: | June 2, 2015 |
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Outline
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Objective: Data on natural growth of intramedullary tumors in patients with NF2 are rare, but indispensable in disease management. The authors’ aim was to evaluate growth rates and patterns of these tumors.
Method: MR images of the spine from 51 patients (20 male, 31 female) suffering from NF2 were screened for intramedullary tumors. The median follow-up time was 55 months (range 5 - 190 months). Tumor volumes were determined by volumetric extrapolation after segmentation in data sets (iPlan software, BrainLAB, Munich) if the tumors met the following inclusion criteria: sagittal T2-weighted MRI scans had to be available from at least two investigations and tumors had to be visible on at least two slices. All tumors that had undergone previous treatment, such as radiation, were excluded from this study. A final set of 42 tumors from 19 patients, that met the inclusion criteria, was included in the growth analysis.
Results: 23 patients (15 female, 11 male) of the 51 patients with spinal imaging harbored intramedullary tumors. There were 68 tumors at the first investigation. Over the course of follow-up, the patients developed 19 additional tumors, resulting in 78 tumors. 23 of the tumors were located in the cervical spine, 19 of them were located in the thoracic spine. The median tumor size after 5 years was 135.94% ± 71.04% compared to baseline. The median time to significant tumor growth was 24 months. Overall, 30 tumors (71.43%) grew, 8 (19.05%) remained stable and 4 (9.52%) decreased in size. The most common growth pattern was ‘saltatory’ growth with intervals between episodes of tumor expansion.
Conclusions: Intramedullary spinal cord tumors are present in about half of the patients with NF2. Usually, these tumors grow slowly. Since there is little room for compensation and little functional regeneration in the spinal medulla, patients should be under constant surveillance in order to identify rapidly growing intramedullary spinal tumors, which need to undergo microsurgical resection.
