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

• Published in: Acta neurochirurgica 2022-10, Vol.164 (10), p.2605-2622
• Main Authors: Baig Mirza, Asfand, Gebreyohanes, Axumawi, Knight, James, Bartram, James, Vastani, Amisha, Kalaitzoglou, Dimitrios, Lavrador, Jose Pedro, Kailaya-Vasan, Ahilan, Maratos, Eleni, Bell, David, Thomas, Nick, Gullan, Richard, Malik, Irfan, Grahovac, Gordan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Astrocytoma; Astrocytoma - surgery; Ependymoma - surgery; Gait; Hemangioblastoma - complications; Hemangioblastoma - diagnostic imaging; Hemangioblastoma - surgery; Humans; Interventional Radiology; Literature reviews; Lymphoma; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Movement disorders; Neurology; Neuroradiology; Neurosurgery; Original Article - Spine - Other; Pain; Patients; Prognosis; Retrospective Studies; Spinal cord; Spinal Cord Neoplasms - diagnostic imaging; Spinal Cord Neoplasms - surgery; Spine - Other; Statistical analysis; Surgery; Surgical Orthopedics; Surgical outcomes; Teratoma; Treatment Outcome; Tumors; Vertebrae; Young Adult
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-022-05304-9

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.