Microsurgical resection of intramedullary spinal cord tumors: clinical efficacy and the medium- and long-term follow-up outcomes

Abstract

Objective To investigate the operation strategies and clinical prognosis of the different pathological types of intramedullary tumors. Methods The clinical data of 178 patients with intramedullary tumor whose tumors were resected by microsurgery under the neural electrophysiological assistance at the Department of Neurosurgery, Tianjin Medical University General Hospital from June 2000 to August 2013 were analyzed retrospectively. Klekamp-Samii (KS) score was used to evaluate the spinal cord function before and after procedure. The follow-up time ≥18 months and surgical resection and recurrence in the patients with different pathological types were evaluated. Results In 178 patients, the symptoms of 142 were improved at 6 months after procedure, 28 did not have any change, and 8 aggravated. In addition astrocytoma, the KS scores of spinal cord function of other types of tumors at six months after surgery were improved significantly compared with before surgery. There was significant difference (P<0.05). The follow-up time of 157 patients were ≥18 months (18 to 78 months, mean 46.6±5.4 months). In 157 patients, 95 were resected totally, 1 (1.1%) had recurrence, 44 were nearly resected totally, and 5 (11.4%) had recurrence; 18 were resected partially and 17 (94.4%) had recurrence. Sixty-eight of them had ependymoma and 68 were resected totally, and none of them had recurrence. Nineteen patients had astrocytoma, 5 were resected totally, and one had recurrence; 14 were resected partially and all had recurrence; 19 had lipoma, 17 were nearly resected totally, and none of them had recurrence; 2 were resected partially and all had recurrence. A total of 22 patients had hemangioblastoma, cavernous hemangioma, hemangioma, hemangiopericytoma, and intestinal cyst, all were resected totally, none of them had recurrence; 15 had epidermoid cyst, all were nearly resected totally, and 3 had recurrence; 14 had dermoid cyst, 12 were nearly resected totally, and 2 had recurrence; 2 were resected partially and one had recurrence. Conclusions Micrographic surgery is safe and effective for the treatment of intramedullary spinal cord tumors. The histological types of the tumors and the range of tumor resection are the important reasons for the decision of the medium- and long-term efficacy. Key words: Spinal cord neoplasms; Microsurgery; Pathology, surgical; Follow-up studies