Tropeano MP, Rossini Z, Franzini A, Baram A, Creatura D, Raspagliesi L, Pessina F, Fornari M. Predictive factors of long-term neurological outcome and progression-free survival in intramedullary spinal cord tumors: a 10-year single-center cohort study and review of the literature.
World Neurosurg 2024:S1878-8750(24)00586-2. [PMID:
38608817 DOI:
10.1016/j.wneu.2024.04.024]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND
Intramedullary spinal cord tumors (IMSCTs) are a rare subgroup of neoplasms, encompassing both benign, slow-growing masses and malignant lesions; radical surgical excision represents the cornerstone of treatment for such pathologies regardless of histopathology, which, on the other hand, is a known predictor of survival and neurological outcome post-surgery. The present study aims to investigate the relevance of other factors in predicting survival and long-term functional outcome.
METHODS
We conducted a review of current literature on functional outcomes of IMSCTs, as well as a 10-years prospective analysis of a wide cohort of patients with diagnosis of IMSCTs who underwent surgical resection at our Institution.
RESULTS
Our series encompasses 60 patients with IMSCTS, among which 36 ependymomas, 6 cavernous angiomas, 5 hemangioblastomas, 6 WHO Grade I-IV astrocytomas, 3 intramedullary spinal metastases and 4 miscellaneous tumors. GTR was achieved in 76,67% of patients, with high preoperative McCormick grade, syringomyelia and changes at neurophysiologic monitoring being the strongest predictors at multivariate analysis (p=0.0027, p=0.0017 and p=0.001 respectively).
CONCLUSION
Consistently with literature, preoperative neurological function is the most important factor predicting long-term functional outcome (0.17, CI 0.069-0.57 with p=0.0018), advocating for early surgery in the management of IMSCTs, whereas late complications such as myelopathy and neuropathic pain where present regardless of preoperative function.
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