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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Intramedullary lesions of the spinal cord – experiences from 426 cases

Meeting Abstract

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  • Christian Mende - Universitätsklinikum Hamburg Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
  • Manfred Westphal - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Sven O. Eicker - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 005

doi: 10.3205/17dgnc568, urn:nbn:de:0183-17dgnc5685

Published: June 9, 2017

© 2017 Mende et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Intramedullary spinal cord tumors are rare entities of the central nervous system. The treatment of choice is resection, sometimes followed by adjuvant radio- or chemotherapy. The feasibility of surgery as the primary treatment of choice is demonstrated within our study.

Methods: We retrospectively identified 426 cases of 398 patients who received surgery for intramedullary lesions. 53% were male, 47% female with a mean age of 42 ± 17 years, a minimum age of 1 and a maximum of 86 years. Cooper Epstein Grades were available pre-op for 91.5%, for 85% at fo9llow up and for 6 months follow up for 47%. Tumor length measured in spinal segments, localization within the spinal column (cervical, thoracic, conus), singularity of the lesion and pre-op progression were recorded as well as the extent of resection and the operative approach. Crosstables and logistic regression were used for statistical evaluation.

Results: 154 (38.7%) patients presented with ependymoma, 71 (17.8%) with astrocytoma, 46 (11.6%) with cavernoma, 54 (13.6%) with hemangioblastoma, 11 (2.8%) with lipoma and ganglioglioma respectively, 7 (1.8%) were benign cysts, 4 (1.0%) presented with glioblastoma of the spinal cord and 3 (0.8%) with oligodendroglioma, 1 patient had spinal intramedullary teratoma (0.3%). In 3 cases (0.8%) inflammation was the cause of the tumorous lesion and in 10 cases (2.5%) no diagnosis was found. 51.1% of all tumors were found on a cervical level, 41.4% on a thoracic level and 7.5% at the conus medullaris. 89 patients were seen again for tumor recurrence, 24 of those were operated again.

Cooper and Epstein grades on discharge were good for the lower extremities (0-1) for 46%, 28% were able to walk using a cane or walker (p<0.001). Regarding the upper extremities, 67.4% had intact neurology or only sensory symptoms (grade 0-1). 20.1% showed mild motor deficit at discharge and 12.6% had major neurologic deficit at discharge (p<0.001). During follow up, 40.2% of all patients improved for their upper extremities, 24% improved regarding the lower extremities (p<0.001). Concerning preoperative status 15.2% improved for the lower extremity and 26.2% for the upper extremity. If sorted by localization, 12.3% of all cervical tumors improved, only 3.9% of all thoracic tumors improved and no conus tumor improved but 16.7% deteriorated (p=0.002) regarding neurologic function of the upper extremities. For the lower extremities 8.9% of all cervical tumors improved, 6.5% of all thoracic tumors improved and 12.5% of the conus tumors improved at discharge (p=0.005).

Conclusion: Surgery is a relatively safe option for the variety of intramedullary lesions for a significant number of patients. Further restitution after discharge can be expected during the follow up and especially for cervical tumors, whereas neurologic dysfunction by thoracic lesions may tend to persist or aggravate in the course of surgery.