Primary spinal intramedullary astrocytomas; long-term outcomes and literature review

Abstract

BackgroundSpinal cord astrocytomas are rare intramedullary tumors. The optimal management of these rare tumors is still controversial. In addition, the different histopathological subclassification and diversity in management protocols complicated the outcome of the disease. We aim to present our long-term outcome of different subtypes of spinal astrocytomas and contribute to the overall understanding of this rare disease. MethodsA retrospective descriptive cohort study of surgical cases managed between June 2001 and December 2019 was carried out. We included the clinical, radiological studies, histological findings, treatment strategies, and surgical outcomes for all operated patients with histologically proven intramedullary spinal astrocytoma. American Spinal Injury Association (ASIA) impairment scale was used to assess the neurological status of patients. ResultsA total of 21 patients were identified. The patients’ median (IQR) age at the time of surgery was 22 years (range 2–63 years). Gross total resection (GTR), subtotal resection (STR), and extended biopsy with duraplasty (Ext. Bx) were the surgical options. Two main categories were identified: diffuse fibrillary astrocytoma (DFA) in 11 patients and pilocytic astrocytoma (PA) in the other 10 patients. Postoperative adjuvant radiotherapy (RT) was used in 9 patients. The median (IQR) follow-up period was 69 months (range 2–237 months). ConclusionConcerning the subclassification of spinal astrocytoma, each group, DFA & PA, has a different natural history and proposed management profiles. Early intervention is highly advocated to provide stability or improvement in the neurological outcomes in the long term. Laminectomy with extended safe resection is the recommended surgical intervention for cases of PA. On the other side, limited safe resection is the choice for DFA patients of any grade. Radiation therapy should be preserved only to DFA when resection is incomplete, has high-grade tumors, or in cases of recurrences.