Institutional experience of surgical management of intramedullary spinal cord tumours

Authors

  • B. D. Bharath Singh Naik Department of Neurosurgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
  • Kadali Satyavara Prasad Department of Neurosurgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
  • Phaneeswar Thota Department of Neurosurgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
  • Raman B. V. S. Department of Neurosurgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20170925

Keywords:

Astrocytoma, CUSA, Ependymoma, Intramedullary spinal cord tumours, Microsurgical techniques, Midline myelotomy

Abstract

Background: Intramedullary spinal cord tumors are rare entity accounting for only 5-6% of all central nervous system tumors. Much literature is not available regarding these tumors owing to their rarity. Present study includes 24 cases of intramedullary spinal cord tumors with pain and progressive weakness. Radiological evaluation showed various intramedullary lesions like ependymoma, astrocytoma, epidermoid etc. spreading over various levels of spinal cord like cervicomedullary, cervicodorsal and dorsal cords.

Methods: The study included all the cases admitted with intramedullary spinal cord tumors in neurosurgery ward in King George hospital, Visakhapatnam, Andhra Pradesh, India during a period of three years from 2014 to 2016. Clinical profile of the patients was analyzed for the clinical presentation, age and sex distribution, histopathological study, pre-and postoperative neurological status, complications and functional outcome. All the patients are followed for a period of 6months to 3years.

Results: Of the 24 cases, most common age group was second (7 patients) and third (7 patients) decades which is upto 29.16% each.  Males (16 patients) are more affected than females in 66.66%. Ependymoma is the most common tumor seen in 41.66% (10 patients) followed by astrocytoma in 33.33% (8 patients). The surgical technique, extent of resection, pre and postoperative neurological status and functional outcome are discussed.

Conclusions: Intramedullary tumours occur commonly among males in the 2nd to 4th decades. Among the intramedullary tumours ependymoma from the commonest lesion subtypes. Most common location is cervical cord segment. Ependymomas have a good plane of cleavage and are thus amenable to radical excision. Patients with good Mc Cormicks grade in pre-operative stage are more amenable for total or near total excision. Prognostic factors affecting outcome are the preoperative neurological status, the plane of cleavage, the extent of resection, the nature and subtype of the lesion. With the improvement in microsurgical techniques and novel adjunctive like MRI, CUSA and intraoperative neurophysiological monitoring, surgery for intramedullary lesions can be carried out with acceptable morbidity and mortality. 

Author Biography

B. D. Bharath Singh Naik, Department of Neurosurgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

DEPARTMENT OF NEUROSURGERY

RESIDENT

References

Constantini S, Houten J, Miller DC. Intramedullary spinal cord tumors in children under the age of 3 years. J Neurosurg. 1996;85:1036-43.

Parsa A, Tihan T, McCormick PC. Spinal axis tumors. In: Berger M, Prados M, eds. Textbook of neuro-oncology. Philadelphia: Elsevier Saunders; 2005:476-84.

Nair S, Menon G, Rao BRM, Rajesh BJ, Muthuretnam T, Mathew A, et al. In: Kanno T, Kato Y, eds. Minimally Invasive Neurosurgery and Multidisciplinary Neurotraumatology. Springer-Verlag, Tokyo; 2006:36-46.

McCormick PC, Torres R, Post KD Stein BM, Intramedullary ependymomas of the spinal cord. J Neurosurg. 1990;72:523-32.

Greenwood J Jr: Total removal of intramedullary tumours. J Neurosurg. 1954;11:616- 21.

Greenwood J: Intramedullary tumors of spinal cord: A follow-up study after total surgical removal. J Neurosurg. 1963;20:665-8.

Chang UK, Choe WJ, Chung SK. Surgical outcome and prognostic factors of spinal intramedullary ependymomas in adults. J Neurooncol. 2002;57:133-9.

Epstein FJ, Farmer JP, Freed D. Adult intramedullary spinal cord ependymomas: the result of surgery in 38 patients. J Neurosurg. 1993;79:204-9.

McCormick PC, Stein BM. Intramedullary tumors in adults. Neurosurg Clin N Am. 1990;l:609-30.

Cooper PR: Outcome after operative treatment of intramedullary spinal cord tumors in adults: Intermediate and long-term results in 51 patients. Neurosurgery. 1989;25:855-9.

Loris C, Hans-Dietrich H. Surgical Management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery. 1994;35(1):69-76.

Sandler HM, Papadopoulos SM, Thornton AF Jr. Spinal cord astrocytomas: results of therapy. Neurosurgery. 1992;30(4):490-3.

Peker S, Ozgen S, Ozek MM. Surgical treatment of intramedullary spinal cord ependymomas: can outcome be predicted by tumor parameters? J Spinal Disord Tech. 2004;17:516-21.

Samii M, Klekamp J. Surgical results of 100 intramedullary tumors in relation to accompanying syringomyelia. Neurosurgery. 1994;35:865-73.

Epstein FJ, Farmer JP, Freed D: Adult intramedullary astrocytomas of the spinal cord. J Neurosurg. 1992;77:355-9.

Epstein F, Epstein N. Surgical treatment of spinal cord astrocytomas of childhood. A series of 19 patients. J Neurosurg. 1982;57:685-9.

Shrivastava RK, Epstein FJ, Perin NI. Intramedullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis. J Neurosurg Spine. 2005;2:249-55.

Chandy MJ, Babu S. Management of intramedullary spinal cord tumours: review of 68 patients. Neurology India. 1990;47:224-8.

Sandalcioglu IE, Gasser T, Asgari S. Functional outcome after surgical treatment of intramedullary spinal cord tumors: expenence with 78 patients. Spinal Cord. 2005;43:34-41.

Cohen AR, Wisoff JH, Allen JC, Epstein FJ. Malignant astrocytoma of spinal cord. J Neurosurg. 1989;70:50-4.

Hoshimaru M, Koyama T, Hashimoto N. Results of microsurgical treatment for intramedullary spinal cord ependymomas: analysis of 36 cases. Neurosurgery. 1999;44:264-9.

Cramer FJ, Elsberg CA. ln: Bucy PC, ed. Neurosurgical Giants: feet of clay and iron. Elsevier Science Publishing; 1985:355-360.

Nair S, Pai KM, Menon G. Management of Intramedullary lesions. Progress in clinical Neurosciences. 1997;12:331-43.

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Published

2017-03-28

How to Cite

Singh Naik, B. D. B., Prasad, K. S., Thota, P., & B. V. S., R. (2017). Institutional experience of surgical management of intramedullary spinal cord tumours. International Journal of Research in Medical Sciences, 5(4), 1319–1324. https://doi.org/10.18203/2320-6012.ijrms20170925

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Original Research Articles