Predictive factors of long-term neurological outcome and progression-free survival in intramedullary spinal cord tumors: a 10-year single-center cohort study and review of the literature.

Abstract

Intramedullary spinal cord tumors (IMSCTs) are a rare subgroup of neoplasms, encompassing both benign, slow-growing masses and malignant lesions; radical surgical excision represents the cornerstone of treatment for such pathologies regardless of histopathology, which, on the other hand, is a known predictor of survival and neurological outcome post-surgery. The present study aims to investigate the relevance of other factors in predicting survival and long-term functional outcome. We conducted a review of current literature on functional outcomes of IMSCTs, as well as a 10-years prospective analysis of a wide cohort of patients with diagnosis of IMSCTs who underwent surgical resection at our Institution. Our series encompasses 60 patients with IMSCTS, among which 36 ependymomas, 6 cavernous angiomas, 5 hemangioblastomas, 6 WHO Grade I-IV astrocytomas, 3 intramedullary spinal metastases and 4 miscellaneous tumors. GTR was achieved in 76,67% of patients, with high preoperative McCormick grade, syringomyelia and changes at neurophysiologic monitoring being the strongest predictors at multivariate analysis (p=0.0027, p=0.0017 and p=0.001 respectively). Consistently with literature, preoperative neurological function is the most important factor predicting long-term functional outcome (0.17, CI 0.069-0.57 with p=0.0018), advocating for early surgery in the management of IMSCTs, whereas late complications such as myelopathy and neuropathic pain where present regardless of preoperative function.