Surgical Treatment Outcomes of Patients with Conus Medullaris Teratoma: A Single-Center Experience of 39 Patients

Abstract

Conus medullaris teratomas are extremely rare, and the treatment experience has been limited. The purpose of the present study was to evaluate the clinical characteristics, radiological features, surgical outcomes, and prognosis of patients with conus medullaris teratoma. We retrospectively reviewed the data from 39 patients who had undergone surgical resection for conus medullaris teratomas from January 2008 to December 2018. All the operations were performed by 1 senior doctor. The clinical features, pre- and postoperative magnetic resonance imaging findings, pathological features, treatment strategies, and outcomes were analyzed. The neurological status was evaluated using the modified Japanese Orthopaedic Association scale score. Of the 39 patients, the mean age was 30.9 years. Of the 39 patients, 20 were male and 19 were female. The symptom duration ranged from 0.3 to 252 months (mean, 61.6 months). Bladder and bowel dysfunction was the most common symptom (76.9%). Total resection was achieved in 25 patients (64.1%), subtotal resection in 11 (28.2%), and partial resection in 3 (7.7%). A mature teratoma was confirmed in all 39 patients. The neurological outcomes were improved 16 patients (45.7%), stable in 14 (40.0%), and aggravated in 5 (14.3%) at a mean follow-up of 62.7 months. Recurrence developed in 1 patient who had undergone subtotal resection. A second surgery with total resection was performed, and the patient's neurological symptoms were stable during follow-up. Total surgical resection is the optimal treatment strategy for patients with conus medullaris teratoma. Safe maximum tumor removal and residual tumor inactivation using electrocoagulation are recommended when total resection cannot be achieved. Surgery can provide a low recurrence rate and an acceptable low complication rate.