Aggressive surgery for intramedullary tumor of cervical spinal cord

Intramedullary tumors of the cervical spinal cord are common and many believe they are amenable to an aggressive approach. However, surgical removal of intramedullary tumors of the cervical spinal cord is still controversial because of the great risk of respiratory dysfunction or quadriplegia or both upon resection of the tumor.

We present a consecutive series of 58 patients who underwent surgical treatment for intramedullary tumors of the cervical spinal cord. Surgical results are analyzed to refine our indications for surgery and its timing. The roles of preoperative radiotherapy and posttherapeutic cord appearance and function are discussed.

Tumors were totally resected in 50 (86.2%), subtotally in seven and partially in one patient. Forty-five (77.6%) patients had improved neurologic status postoperatively. Intramedullary tumors in the cervical area have better results from surgery than intramedullary tumors in other levels of the spine. Patients with moderate neurologic deficits can recover remarkably well after total tumor removal. Laser surgery is especially helpful for lipoma. Preoperative radiotherapy should be avoided because it is associated with difficult surgery and poor clinical outcome. The thin spinal cord can function surprisingly well.

We conclude that intramedullary tumors of the cervical spinal cord are amenable to total surgical removal. Surgery is suitable when a patient presents with a moderate neurologic deficit. Proficient surgical technique for total tumor resection is necessary for good results. Preoperative radiotherapy contributes to difficult surgery and poor prognosis, and is not recommended.