OUTCOME OF INTRAMEDULLARY SPINAL CORD TUMOURS: EXPERIENCE WITH 18 PATIENTS OPERATED AT AYUB TEACHING HOSPITAL, ABBOTTABAD
AbstractBackground: Intramedullary spinal cord tumours (IMSCT) are among the uncommon lesions at spinalcord. They can present with a vast array of symptoms and cause severe neurological deficits. Withadvent and frequent use of MRI more and more patients with IMSCT are picked up. By using modernmicrosurgical techniques better surgical outcome is achieved. The Objective was to analyse the surgicaloutcome of the patients with intramedullary Spinal Tumour operated at Ayub Teaching Hospital(ATH), Abbottabad. Methods: Eighteen patients with IMSCT who presented at Neurosurgery Unit,ATH, Abbottabad during 2000–2010 were included in this study. Patients were diagnosed on the basisof MRI. They were operated using standard microsurgical techniques. Patients were followed up for amean duration of 18 months after surgery and their preoperative and postoperative neurological statuswas analysed. Results: Patients with age group ranging from 15–50 (37.72±8.94) years with IMSCTwere operated. Sixty-one percent of the patients were male and 39% were female. The region mostcommonly affected was cervical (44%) followed by conus medullaris (33%), cervicothoracic andthoracic each had frequency of 11%. Gross total removal (>95%) was possible in 72% of cases while inrest of 28% cases resection of 80–95% was possible. Histologically 38.9% of the lesions wereependymomas, 27.8% were astrocytomas and 22.2% were teratomas. Neurofibromas and PrimitiveNeuroectodermal Tumours (PNET) each accounted for 5.5% of the cases. Overall postoperativeneurology improved in 10 (55%) of patients, remained unchanged in 5 (27%) of cases, and deterioratedin 3 (16%) patients. One patient was lost in follow-up. Surgery on tumours in cervical and thoracicregion carried a relatively poor outcome as compared to the lesion of conus. There were no deaths dueto surgery. Conclusion: Surgical removal of IMSCT is beneficial to patients with acceptable surgicalrisk. Better outcome is expected if the patients with good Frankel grade are diagnosed and operatedearly the course of disease.Keywords: Spinal tumours, Intramedullary spinal tumour, Ependymoma
Van Goethem JW, van den Hauwe L, Ozsarlak O, De Schepper
AM, Parizel PM. Spinal tumours. Eur J Radiol 2004;50(2):159–76.
Bowers DC, Weprin BE. Intramedullary Spinal Cord Tumours.
Curr Treat Options Neurol 2003;5:207–12.
Sandalcioglu IE, Gasser T, Asgari S, Lazorisak A, Engelhorn T,
Egelhof T, et al. Functional outcome after surgical treatment of
intramedullary spinal cord tumours: experience with 78 patients.
Spinal Cord 2005;43:34–41.
Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein
FJ. Radical excision of intramedullary spinal cord tumours: surgical
morbidity and long-term follow-up evaluation in 164 children and
young adults. J Neurosurg 2000;93(2 Suppl):183–93.
Miller DC. Surgical pathology of intramedullary spinal cord
neoplasms. J Neurooncol 2000;47:189–94.
Cooper PR, Epstein F. Radical resection of intramedullary spinal
cord tumours in adults. Recent experience in 29 patients. J
Bouffet E, Pierre-Kahn A, Marchal JC, Jouvet A, Kalifa C,
Choux M, et al. Prognostic factors in pediatric spinal cord
astrocytoma. Cancer 1998;83:2391–9.
Guidetti B, Mercuri S, Vagnozzi R: Long-term results of the
surgical treatment of 129 intramedullary spial gliomas. J
Hardison HH, Packer RJ, Rorke LB, Schut L, Sutton LN, Bruce
DA. Outcome of children with primary intramedullary spinal
cord tumours. Childs Nerv Syst 1987;3(2):89–92.
O'Sullivan C, Jenkin RD, Doherty MA, Hoffman HJ, Greenberg
ML. Spinal cord tumours in children: long-term results of
combined surgical and radiation treatment. J Neurosurg
Przybylski GJ, Albrigh AL, Martinez AJ: Spinal cord
astrocytomas: long-term results comparing treatments in children.
Childs Nerv Syst 1997;13:375–82.
Ohata K, Takami T, Gotou T, El-Bahy K, Morino M, Maeda M,
et al. Surgical outcome of intramedullary spinal cord
ependymoma. Acta Neurochir (Wien) 1999;141:341–6.
Sala F, Bricolo A, Faccioli F, Lanteri P, Gerosa M. Surgery for
intramedullary spinal cord tumours: the role of intraoperative
neurophysiological) monitoring. Eur Spine J 2007;16(Suppl
Wiedemayer H, Fauser B, Sandalcioglu IE, Schafer H, Stolke D.
The impact of neurophysiological intraoperative monitoring on
surgical decisions: a critical analysis of 423 cases. J Neurosurg
Sandalcioglu IE, Gasser Th, Wiedemayer H, Horsch S, Stolke D.
Favourable outcome after biopsy and decompression of a
holocord intramedullary spinal cord astrocytoma in a newborn.
Eur J Paediatr Neurol 2002;6:179–82.
Hoshimaru M, Koyama T, Hashimoto N, kikuchi H. Results of
microsurgical treatment for intramedullary spinal cord
ependymomas: analysis of 36 cases. J Neurosurgery
Kane PJ, EI-Mahdy W, Singh A, Powell MP, Crockard HA.
Spinal intradural tumours: Part-II–intramedullary. Br J Neurosurg