114 Paediatric spinal cord intramedullary gliomas safe maximal extent of resection to optimize neurological and oncological outcomes

• Published in: Archives of disease in childhood 2020-11, Vol.105 (Suppl 2), p.A39-A39
• Main Authors: Valetopoulou, Alexandra, Constantinides, Maria, Silva, Dulanka, Thompson, Dominic
• Format: Article
• Language: English
• Subjects: Children; Glioma; Magnetic resonance imaging; Morbidity; Motor evoked potentials; Outcome Measures; Patients; Pediatrics; Spinal cord; Surgery; Survival; Tumors
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2020-gosh.114

ObjectiveLow grade intramedullary spinal cord tumours (IMSCTs) are rare tumours of childhood with potential for significant late morbidity following surgery.We present our institutional experience with surgical treatment of these complex lesions emphasizing consistent definition of extent of resection (EOR), techniques to maximise surgical safety and a novel stratification of residual disease to guide post-operative strategy.MethodsA retrospective review of low-grade IMSCTs treated at GOSH between 2000 and 2019 was conducted. All surgery carried out by a single surgeon with intent of safe maximal resection guided by intra-operative neurophysiological monitoring (IONM). Pre and post-operative MRI were reviewed by neuro-radiologists.EOR was recorded as:Gross Total Resection (GTR) –100% resectionNear Total Resection (NTR) – at least 95% resectionSub Total Resection (STR) – 90% tumour resectionPartial Resection (PR) – less than 90% tumour resectionFurther outcome measures were time to recurrence, need for adjuvant therapy and mobility at last follow-up.ResultsA total of 30 patients underwent surgery. IONM parameters (Motor evoked potentials,D-wave) were used to guide EOR. EORs achieved: GTR = 8, NTR = 4, STR = 9, PR = 9.All patients were alive at last follow up with eighteen patients (60%) remaining radiologically and clinically stable. Twelve patients developed recurrence/progressive disease during surveillance (40%) requiring adjuvant treatment. Progression free survival was significantly better in cases with GTR+NTR in comparison to either STR or PR.Following surgery, 26/30 patients were independently mobile, 1/30 required crutches and 3/30 required a wheelchair.9/30 patients were treated with adjuvant therapy following surgery.ConclusionSurvival rates for low grade IMSCT are excellent. Radical micro-surgical resection, guided by IONM provides an effective means of balancing the objectives of maximal safe resection, functional outcome and tumour control. Small volume residual disease does not compromise long-term oncological outcome.