Spinal intramedullary tumors. When is surgical treatment indicated?

Abstract

Timing of surgery in patients with intramedullary tumors is the subject of controversy. The aim of this retrospective study is to evaluate whether patients with intramedullary ependymomas and astrocytomas have a better postoperative prognosis without or with slight preoperative deficits than those with severe preoperative neurological disturbances. During a period of 8.5 years (January 1992-August 2000), 34 patients with intramedullary tumors underwent surgery in our Neurosurgical Department. Among them there were five astrocytomas WHO grade II and ten ependymomas WHO grade II. Recurrences were observed in two patients with astrocytomas and one patient with ependymoma. Pre- and postoperative functional performance was classified according to the McCormick scale in grade I-IV (grade I: neurologically normal or mild focal deficit and grade IV: severe neurological deficits and without functional independence). The follow-up period varied from 4 to 76 months (mean: 27.9 months). All seven grade I patients remained unchanged after surgery. Two of four grade II patients improved to grade I; two deteriorated to grade III. Two of three grade III and IV patients remained unchanged and another one deteriorated from grade III to IV. At the best, intramedullary astrocytomas and ependymomas should be operated when symptoms are mild. Early surgery can achieve good functional outcome.