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Management of intramedullary spinal cord lesions: interdependence of the longitudinal extension of the lesion and the functional outcome

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Abstract

To evaluate the impact of the longitudinal extension of intramedullary lesions on the neurological status and postoperative outcome. Forty-six patients operated in our Department between February 2004 and June 2007 have been included in this study. The patients were classified in two groups according to the longitudinal extension of the lesion over less than three vertebral segments (group A) and over exactly three or more vertebral segments (group B). The neurological status was assessed preoperatively, postoperatively and after 3 months and involved both the McCormick (McC) and Klekamp–Samii (KS) scales. The preoperative McC- and KS scores of the patients of group B were statistically significant lower (p < 0.038 and p < 0.027, respectively) than those of group A. Patients of both groups showed an initial postoperative clinical deterioration. The level of statistical significance was reached only in group B (group A McC p < 0.170, KS p < 0.105; group B McC p < 0.012, KS p < 0.020). The patients recovered well and no statistical difference was observed between the preoperative and the 3-month follow-up scores (group A McC p < 0.490, KS p < 0.705; group B McC p < 0.506, KS p < 0.709). Thus, patients with extended intramedullary lesions have a worse neurological status preoperatively, postoperatively and in the 3-month follow-up. The preoperative neurostatus is determinant for the outcome. Even in case of longitudinally extensive intramedullary lesions, early surgery is recommended since satisfactory results can be achieved.

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References

  1. Brotchi J, Dewitte O, Levivier M, Balériaux D, Vandesteene A, Raftopoulos C, Flament-Durand J, Noterman J (1991) A survey of 65 tumors within the spinal cord: surgical results and the importance of preoperative magnetic resonance imaging. Neurosurgery 29:651–656

    Article  CAS  PubMed  Google Scholar 

  2. Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ (2000) Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg 93:183–193

    Article  CAS  PubMed  Google Scholar 

  3. Cooper PR, Epstein F (1985) Radical resection of intramedullary spinal cord tumors in adults. Recent experience in 29 patients. J Neurosurg 63:492–499

    Article  CAS  PubMed  Google Scholar 

  4. Cristante L, Herrmann HD (1994) Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery 35:69–74

    Article  CAS  PubMed  Google Scholar 

  5. Deletis V, Sala F (2008) Intraoperative neurophysiological monitoring of the spinal cord during spinal cord and spine surgery: a review focus on the corticospinal tracts. Clin Neurophysiol 119:248–264

    Article  PubMed  Google Scholar 

  6. Epstein FJ, Farmer JP, Freed D (1992) Adult intramedullary astrocytomas of the spinal cord. J Neurosurg 77:355–359

    Article  CAS  PubMed  Google Scholar 

  7. Guidetti B, Mercuri S, Vagnozzi R (1981) Long-term results of the surgical treatment of 129 intramedullary spinal gliomas. J Neurosurg 54:323–330

    Article  CAS  PubMed  Google Scholar 

  8. Klekamp J, Samii M (1993) Introduction of a score system for the clinical evaluation of patients with spinal processes. Acta Neurochir 123:221–223

    Google Scholar 

  9. Kothbauer K, Deletis V, Epstein FJ (1997) Intraoperative spinal cord monitoring for intramedullary surgery: an essential adjunct. Pediatr Neurosurg 26:247–254

    Article  CAS  PubMed  Google Scholar 

  10. McCormick PC, Torres R, Post KD, Stein BM (1990) Intramedullary ependymoma of the spinal cord. J Neurosurg 72:523–532

    Article  CAS  PubMed  Google Scholar 

  11. McGirt MJ, Chaichana KL, Atiba A, Attenello F, Woodworth GF, Jallo GI (2008) Neurological outcome after resection of intramedullary spinal cord tumors in children. Childs Nerv Syst 24:93–97

    Article  PubMed  Google Scholar 

  12. Nakamura M, Ishii K, Watanabe K, Tsuji T, Takaishi H, Matsumoto M, Toyama Y, Chiba K (2008) Surgical treatment of intramedullary spinal cord tumors: prognosis and complications. Spinal Cord 46:282–286

    Article  CAS  PubMed  Google Scholar 

  13. 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 56:972–981

    PubMed  Google Scholar 

  14. Sala F, Bricolo A, Faccioli F, Lanteri P, Gerosa M (2007) Surgery for intramedullary spinal cord tumors: the role of intraoperative (neurophysiological) monitoring. Eur Spine J 16:130–139

    Article  Google Scholar 

  15. Sala F, Palandri G, Basso E, Lanteri P, Deletis V, Faccioli F, Bricolo A (2006) Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery 58:1129–1143

    Article  PubMed  Google Scholar 

  16. Samii M, Klekamp J (1994) Surgical results of 100 intramedullary tumors in relation to accompanying syringomyelia. Neurosurgery 35:865–873

    Article  CAS  PubMed  Google Scholar 

  17. Sandalcioglu IE, Gasser T, Asgari S, Lazorisak A, Engelhorn T, Egelhof T, Stolke D, Wiedemayer H (2005) Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients. Spinal Cord 43:34–41

    Article  CAS  PubMed  Google Scholar 

  18. Tobias ME, McGirt MJ, Chaichana KL, Goldstein IM, Kothbauer KF, Epstein F, Jallo GI (2008) Surgical management of long intramedullary spinal cord tumors. Childs Nerv Syst 24:219–223

    Article  PubMed  Google Scholar 

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Correspondence to Florian H. Ebner.

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Ebner, F.H., Roser, F., Falk, M. et al. Management of intramedullary spinal cord lesions: interdependence of the longitudinal extension of the lesion and the functional outcome. Eur Spine J 19, 665–669 (2010). https://doi.org/10.1007/s00586-009-1232-1

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  • DOI: https://doi.org/10.1007/s00586-009-1232-1

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