Skip to main content

Advertisement

SpringerLink
Log in

Prognostic factors for surgically managed intramedullary spinal cord tumours: a single-centre case series

  • Original Article - Spine - Other
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Purpose

Intramedullary spinal cord tumours (IMSCTs) are comparatively rare neoplasms. We present a single-centre clinical case series of adult patients with surgically managed IMSCTs.

Methods

We performed a retrospective analysis of electronic patient records in the time period spanning July 2010 to July 2021. All adult patients that had undergone surgical management for IMSCTs were eligible for inclusion. Baseline and post-operative clinical and radiological characteristics, along with follow-up data, were assessed. We also performed a literature review with a focus on surgical outcomes for IMSCTs.

Results

Sixty-six patients matched our selection criteria, with a median age of 42 years (range 23–85). Thirty-four ependymomas, 17 haemangioblastomas, 12 astrocytomas, 2 lymphomas and 1 teratoma were included. Statistical analysis yielded several significant findings: IMSCTs spanning a greater number of vertebral levels are significantly associated with poor McCormick outcomes (p = 0.03), presence of gait disturbance before surgery is significantly associated with poor outcome for both post-operative McCormick and Nurick scores (p = 0.007), and radicular pain present pre-operatively is significantly associated with a good post-operative McCormick score (p = 0.045). Haemangioblastomas are significantly more likely to have a clear intra-operative dissection plane compared to ependymomas and astrocytomas (p = 0.009). However, astrocytomas have a significantly higher prevalence of good McCormick outcomes compared to ependymomas and haemangioblastomas (p = 0.03).

Conclusion

Histological diagnosis, cranio-caudal extent of the tumour and the presence or absence of baseline deficits—such as gait impairment and radicular pain—are significant in determining neurological outcomes after surgery for IMSCTs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ANOVA:

Analysis of variance

ASIA:

American Spinal Cord Injury Association

CNS:

Central nervous system

GTR:

Gross total resection

IMSCT:

Intramedullary spinal cord tumour

IONM:

Intra-operative neuromonitoring

MRI:

Magnetic resonance imaging

OR:

Odds ratio

STR:

Subtotal resection

WHO:

World Health Organization (for histopathological grading of tumours)

References

  1. Abdullah KG, Lubelski D, Miller J, Steinmetz MP, Shin JH, Krishnaney A, Mroz TE, Benzel EC (2015) Progression free survival and functional outcome after surgical resection of intramedullary ependymomas. J Clin Neurosci. https://doi.org/10.1016/j.jocn.2015.06.017

    Article  PubMed  Google Scholar 

  2. Abul-Kasim K, Thurnher MM, McKeever P, Sundgren PC (2008) Intradural spinal tumors: current classification and MRI features. Neuroradiology. https://doi.org/10.1007/s00234-007-0345-7

    Article  PubMed  Google Scholar 

  3. Aghakhani N, David P, Parker F, Lacroix C, Benoudiba F, Tadie M (2008) Intramedullary spinal ependymomas: analysis of a consecutive series of 82 adult cases with particular attention to patients with no preoperative neurological deficit. Neurosurgery. https://doi.org/10.1227/01.neu.0000333299.26566.15

    Article  PubMed  Google Scholar 

  4. Asaid M, Preece PD, Rosenthal MA, Drummond KJ (2015) Ependymoma in adults: local experience with an uncommon tumour. J Clin Neurosci. https://doi.org/10.1016/j.jocn.2015.03.020

    Article  PubMed  Google Scholar 

  5. Babu R, Karikari IO, Owens TR, Bagley CA (2014) Spinal cord astrocytomas: a modern 20-year experience at a single institution. Spine. https://doi.org/10.1097/BRS.0000000000000190

    Article  PubMed  Google Scholar 

  6. Badhiwala JH, Farrokhyar F, Alhazzani W et al (2014) Surgical outcomes and natural history of intramedullary spinal cord cavernous malformations: a single-center series and meta-analysis of individual patient data. J Neurosurg Spine. https://doi.org/10.3171/2014.6.SPINE13949

    Article  PubMed  Google Scholar 

  7. Barkley A, McGrath LB, Hofstetter CP (2021) Intraoperative contrast-enhanced ultrasound for intramedullary spinal neoplasms: patient series. J Neurosurg. https://doi.org/10.3171/case2083

  8. Blegvad C, Grotenhuis JA, Juhler M (2014) Syringomyelia: a practical, clinical concept for classification. Acta Neurochir. https://doi.org/10.1007/s00701-014-2229-z

    Article  PubMed  Google Scholar 

  9. Boström A, Kanther NC, Grote A, Boström J (2014) Management and outcome in adult intramedullary spinal cord tumours: a 20-year single institution experience. BMC Res Notes. https://doi.org/10.1186/1756-0500-7-908

    Article  PubMed  PubMed Central  Google Scholar 

  10. Chamberlain MC, Tredway TL (2011) Adult primary intradural spinal cord tumors: a review. Curr Neurol Neurosci Rep. https://doi.org/10.1007/s11910-011-0190-2

    Article  PubMed  Google Scholar 

  11. Chang UK, Choe WJ, Chung SK, Chung CK, Kim HJ (2002) Surgical outcome and prognostic factors of spinal intramedullary ependymomas in adults. J Neurooncol. https://doi.org/10.1023/A:1015789009058

    Article  PubMed  Google Scholar 

  12. Cooper PR (1989) Outcome after operative treatment of intramedullary spinal cord tumors in adults: intermediate and long-term results in 51 patients. Neurosurgery. https://doi.org/10.1227/00006123-198912000-00001

    Article  PubMed  Google Scholar 

  13. Elsberg CA (1925) Some aspects of the diagnosis and surgical treatment of tumors of the spinal cord with a study of the end results in a series of 119 operations. Ann Surg. https://doi.org/10.1097/00000658-192506010-00003

    Article  PubMed  PubMed Central  Google Scholar 

  14. Epstein FJ, Farmer JP, Freed D (1993) Adult intramedullary spinal cord ependymomas: the result of surgery in 38 patients. J Neurosurg. https://doi.org/10.3171/jns.1993.79.2.0204

    Article  PubMed  Google Scholar 

  15. Jokovic M, Somma T, Ilic R, Guizzardi G, Stanimirovic A, Raicevic S, Milicevic M, Grujicic D, Solari D (2021) Primary spinal glioblastoma multiforme. Single center experience and literature review. Interdisciplinary Neurosurgery: Advanced Techniques and Case Management. https://doi.org/10.1016/j.inat.2021.101109

  16. Karikari IO, Nimjee SM, Hodges TR et al (2011) Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients. Neurosurgery. https://doi.org/10.1227/NEU.0b013e3181fe3794

    Article  PubMed  Google Scholar 

  17. Khalid S, Kelly R, Carlton A, Wu R, Peta A, Melville P, Maasarani S, Meyer H, Adogwa O (2019) Adult intradural intramedullary astrocytomas: a multicenter analysis. Journal of Spine Surgery. https://doi.org/10.21037/jss.2018.12.06

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lee SH, Chung CK, Kim CH, Yoon SH, Hyun SJ, Kim KJ, Kim ES, Eoh W, Kim HJ (2013) Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea Spinal Oncology Research Group. Neuro Oncol. https://doi.org/10.1093/neuonc/not038

    Article  PubMed  PubMed Central  Google Scholar 

  19. McCormick PC, Torres R, Post KD, Stein BM (1990) Intramedullary ependymoma of the spinal cord. J Neurosurg. https://doi.org/10.3171/jns.1990.72.4.0523

    Article  PubMed  Google Scholar 

  20. Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. https://doi.org/10.1093/brain/95.1.87

    Article  PubMed  Google Scholar 

  21. Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G (2005) Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery 56(5):972–979

    PubMed  Google Scholar 

  22. Ren J, Hong T, He C, Li X, Ma Y, Yu J, Ling F, Zhang H (2019) Surgical approaches and long-term outcomes of intramedullary spinal cord cavernous malformations: a single-center consecutive series of 219 patients. Journal of Neurosurgery: Spine. https://doi.org/10.3171/2018.12.SPINE181263

  23. Samartzis D, Gillis CC, Shih P, O’Toole JE, Fessler RG (2015) Intramedullary spinal cord tumors: part I-epidemiology, pathophysiology, and diagnosis. Global Spine Journal. https://doi.org/10.1055/s-0035-1549029

    Article  PubMed  PubMed Central  Google Scholar 

  24. Samii M, Klekamp J (1994) Surgical results of 100 intramedullary tumors in relation to accompanying syringomyelia. Neurosurgery. https://doi.org/10.1227/00006123-199411000-00010

    Article  PubMed  Google Scholar 

  25. Samuel N, Tetreault L, Santaguida C, Nater A, Moayeri N, Massicotte EM, Fehlings MG (2016) Clinical and pathological outcomes after resection of intramedullary spinal cord tumors: a single-institution case series. Neurosurgical Focus. https://doi.org/10.3171/2016.5.FOCUS16147

  26. Shih RY, Koeller KK (2020) Intramedullary masses of the spinal cord: Radiologic-pathologic correlation. Radiographics 40(4):1125–1145

    Article  Google Scholar 

  27. Shrivastava RK, Epstein FJ, Perin NI, Post KD, Jallo GI (2005) Intramedullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis. J Neurosurg Spine. https://doi.org/10.3171/spi.2005.2.3.0249

    Article  PubMed  Google Scholar 

  28. Soldozy S, Patel P, Elsarrag M, Norat P, Raper DM, Sokolowski JD, Yağmurlu K, Park MS, Tvrdik P, Kalani MYS (2019) Enhanced recovery after surgery in intramedullary and extramedullary spinal cord lesions: perioperative considerations and recommendations. Spinal Cord. https://doi.org/10.1038/s41393-019-0335-8

    Article  PubMed  Google Scholar 

  29. Soo KM, Kee CC, Choe G, Han KI, Jib KH (2001) Intramedullary spinal cord astrocytoma in adults: postoperative outcome. J Neurooncol. https://doi.org/10.1023/A:1010680924975

    Article  Google Scholar 

  30. Tobin MK, Geraghty JR, Engelhard HH, Linninger AA, Mehta AI (2015) Intramedullary spinal cord tumors: a review of current and future treatment strategies. Neurosurg Focus. https://doi.org/10.3171/2015.5.FOCUS15158

    Article  PubMed  Google Scholar 

  31. Tsai CJ, Wang Y, Allen PK, et al (2014) Outcomes after surgery and radiotherapy for spinal myxopapillary ependymoma: update of the MD anderson cancer center experience. Neurosurgery. https://doi.org/10.1227/NEU.0000000000000408

  32. Velat GJ, Chang SW, Abla AA, Albuquerque FC, Mcdougall CG, Spetzler RF (2012) Microsurgical management of glomus spinal arteriovenous malformations: pial resection technique - clinical article. Journal of Neurosurgery: Spine. https://doi.org/10.3171/2012.3.SPINE11982

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK

    Asfand Baig Mirza, James Knight, James Bartram, Amisha Vastani, Dimitrios Kalaitzoglou, Jose Pedro Lavrador, Ahilan Kailaya-Vasan, Eleni Maratos, David Bell, Nick Thomas, Richard Gullan, Irfan Malik & Gordan Grahovac

  2. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

    Axumawi Gebreyohanes

Authors
  1. Asfand Baig Mirza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Axumawi Gebreyohanes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James Knight
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Bartram
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amisha Vastani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dimitrios Kalaitzoglou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jose Pedro Lavrador
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ahilan Kailaya-Vasan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eleni Maratos
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. David Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Nick Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Richard Gullan
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Irfan Malik
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Gordan Grahovac
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Asfand Baig Mirza.

Ethics declarations

Ethical approval

As a retrospective case series, ethical approval was not required for a study of this type.

Informed consent

All data is anonymised and so informed consent was not required for a study of this type.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Spine - Other

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baig Mirza, A., Gebreyohanes, A., Knight, J. et al. Prognostic factors for surgically managed intramedullary spinal cord tumours: a single-centre case series. Acta Neurochir 164, 2605–2622 (2022). https://doi.org/10.1007/s00701-022-05304-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-022-05304-9

Keywords

Search

Navigation