Microsurgical treatment and functional outcomes of multi-segment intramedullary spinal cord tumors

We aimed to prospectively analyze correlations between clinical features and histological classification of multi-segment intramedullary spinal cord tumors (MSICTs), and the extent of microsurgical resection and functional outcomes. Fifty-six patients with MSICTs underwent microsurgery for tumor removal using a posterior approach. The tumor was exposed through a dorsal myelotomy. Pre-operative and post-operative nervous function was scored using the Improved Japanese Orthopaedic Association (IJOA) grading system. Correlation analyses were performed between functional outcome (IJOA score) and histological features, age, tumor location, and the longitudinal extent of spinal cord involvement. The most frequently involved levels were the medullo cervical and the cervicothoracic regions (51.8%, 29/56) followed by the conus terminalis (26.8%, 15/56) and the thoracic region (14.3%, 8/56). Ependymoma was the most frequent MSICT type, seen in 22 of 56 patients (39%), followed by low grade astrocytoma (17 patients, 30%) and glioblastoma multiforme (3 patients, 5%). Gross total tumor removal was achieved in 33 cases (58%), subtotal resection in 4 (7%), and partial resection in 16 (28%). The histological classification of the tumor was the most important factor influencing the extent of surgical removal (chi2=22.17, p=0.00). The overall difference between pre-operative and post-operative neurological state was not significant (chi2=5.44, p=0.61). Thus, MSICTs were most commonly seen in the medullo cervical and cervicothoracic regions, with ependymoma and low grade astrocytoma the most common tumour types. We stress the importance of early microsurgical treatment for MSICTs while the patients do not have severe dysfunction.