Spinal Cord Tumors—Our 5-Year Experience

Purpose To study the demography, incidence, symptoms, histopathology, postoperative complications and recovery in operated patients of spinal tumor. Overview of Literature Primary spinal cord tumors (SCT) are an uncommon entity. According to their location, spinal tumors are conveniently classified as extradural (ED) and intradural (ID), although some can be both inside and outside the dura. ID tumors can be intradural extramedullary (IDEM) or intramedullary SCT (IMSCT). Methods This is a retrospective study of 122 patients with spinal tumors who were surgically treated at the department of neurosurgery from 2014 to 2019 over a period of 5 years. Study Design This is a retrospective study. Results Out of 122 patients, there were 19 patients with ED tumor, 73 had IDEM, and 30 had IMSCT. As many as 73 patients were males and the rest of the 49 patients were females. Mean age at time of surgery was 40.79 years. The thoracic region of spinal canal was most frequently involved (64; 52.4%). The common clinical symptom was motor weakness (90 cases; 73.77%). Majority of the patients had symptoms for duration of 6 to 12 months. Schwannomas were the most common tumor among IDEM and extradural location. Ependymomas were the most common type in IMSCT. We observed significant improvement in most of our cases. Four patients deteriorated at 3 months follow- up. Conclusions There was a higher male:female ratio for all spinal cord tumors except meningiomas. There was also a higher proportion of nerve sheath tumors, and a lower proportion of meningiomas and neuroepithelial tumors. These results are similar to other studies from Asian countries.

Diffusion tensor imaging in unclear intramedullary tumor-suspected lesions allows separating tumors from inflammation

Design Prospective diagnostic study. Objectives Primary imaging-based diagnosis of spinal cord tumor-suspected lesions is often challenging. The identification of the definite entity is crucial for dedicated treatment and therefore reduction of morbidity. The aim of this trial was to investigate specific quantitative signal patterns to differentiate unclear intramedullary tumor-suspected lesions based on diffusion tensor imaging (DTI). Setting Medical Center - University of Freiburg, Germany. Methods Forty patients with an unclear tumor-suspected lesion of the spinal cord prospectively underwent DTI. Primary diagnosis was determined by histological or clinical work-up or remained indeterminate with follow-up. DTI metrics (FA/ADC) were evaluated at the central lesion area, lesion margin, edema, and normal spinal cord and compared between different diagnostic groups (ependymomas, other spinal cord tumors, inflammations). Results Mean DTI metrics for all spinal cord tumors (n = 18) showed significantly reduced FA and increased ADC values compared to inflammatory lesions (n = 8) at the lesion margin (p < 0.001, p = 0.001) and reduced FA at the central lesion area (p < 0.001). There were no significant differences comparing the neoplastic subgroups of ependymomas (n = 10) and other spinal cord tumors (n = 8), but remaining differences for both compared to the inflammation subgroup. We found significant higher ADC (p = 0.040) and a trend to decreased FA (p = 0.081) for ependymomas compared to inflammations at the edema. Conclusion Even if distinct differentiation of ependymomas from other spinal cord neoplasms was not possible based on quantitative DTI metrics, FA and ADC were feasible to separate inflammatory lesions. This may avoid unnecessary surgery in patients with unclear intramedullary tumor-suspected lesions.

Impact of general anaesthesia on parameters of bulbocavernosus reflex

Dysfunction of the pelvic organs in tumor lesions of the spinal cord is up to 20%. Registration of the bulbocavernosus reflex is performed to assess the integrity of the segmental apparatus of the spinal cord. Polymodal neurophysiological monitoring includes registration of the bulbocavernosus reflex during surgery of spinal cord tumors. The effect of the components of general anesthesia on the parameters of the bulbocavernosus reflex varies significantly according to various medical sources. The aim of the work was to compare the effect of inhalation anesthesia (sevoflurane) and total intravenous anesthesia (propofol) on the parameters of the bulbocavernosus reflex in the surgical treatment of spinal cord tumors. Thirty patients with intradural extramedullary and intramedullary tumors of the spinal cord at the level of Th11–S2 vertebrae were included in the study. The amplitude-frequency parameters of the bulbocavernosus reflex and the threshold intensity of stimulation were assessed in the study. The results of the study demonstrate that intraoperative registration of the bulbocavernosus reflex during resection of tumors of the distal spinal cord can be performed both with inhalation and total intravenous anesthesia. A sustained motor response of the bulbocavernosus reflex requires a higher intensity of stimulation with inhalation anesthesia with sevoflurane than with total intravenous anesthesia. If during the operation the depth of propofol's anesthesia increases by 1 mg/kg/h, then it is necessary to increase the current strength during stimulation by 10–11 mA.

Analysis of Factors Influencing the Long-term Outcome in Primary Spinal Cord Tumors: Review of Literature

Introduction Primary spinal cord tumors are amenable to total surgical excision but the outcomes are still diverse. Objective The purpose of this study is to identify the significant factors which influence the long-term outcome of spinal cord tumors. Materials and Methods A total of 84 consecutive spinal cord tumor patients who underwent microsurgical excision during April 2003 to 2014 were retrospectively studied. Patients operated after April 2014 were not considered. Ten factors were taken and correlated with the outcome. Multiple regression analysis was used. Patients were periodically evaluated at 1, 6 months, 1, 2, and 5 years. In 72 cases, postoperative MRI scans were performed. The follow-up period ranged between 5 to 15 years. Results In our study, we had 64 extramedullary tumors and 21 intramedullary tumors with varied pathology. Axial location of the tumour (20.294/0.000), extent of the resection of the tumour (13.827/0.001), preoperative Nurick grade (11.349/0.023), and location of the tumour in the spine with respect to vertebral segments (8.151/0.017) were significant predictive factors. We had good outcomes in 65 cases and poor outcomes in 19 cases. Conclusion Our results show location of the tumor with respect to axial plane and vertebral segments were the main contributing factors. They influence the extent of excision of the spinal cord tumor. Preoperative neurological status is the fourth factor which independently determines the long-term outcome. It is one of the few papers where patients have been followed-up for a long period ranging from 5 to 15 years.

NCOG-05. RISK FACTORS FOR PROLONGED LENGTH OF STAY AND POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH INTRAMEDULLARY SPINAL CORD TUMORS

INTRODUCTION Primary spine tumors are rare neoplasms that affect about 0.62 per 100,000 individuals in the US. Intramedullary spinal cord tumors (IMSCTs) are the rarest of all primary tumors involving the spine and can cause pain, imbalance, urinary dysfunction and neurological deficits. These types of tumors oftentimes necessitate surgical treatment, yet there is a lack of data on length of stay and complication rates following treatment. Given that treatment candidacy, quality of life, and outcomes are tied so closely to these metrics, it is important to illustrate the risk factors for prolonged length of stay and their association with post-op complications with the ultimate goal of improving patient selection and preoperative optimization. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients undergoing surgery for treatment of intramedullary spinal cord tumors between 2005 and 2017. Univariate and multivariate analysis were performed to assess patient risk factor influencing prolonged length of stay and post-op complications. RESULTS A total of 638 patients were included in the analysis. Pre-operative American Society of Anesthesiology (ASA) physical status classification of 3 and above ( OR 1.89; p=0.0005), dependent functional status ( OR 2.76; p=0.0035) and transfer from facilities other than home ( OR 8.12; p&lt; 0.0001) were independent predictors of prolonged length of stay ( &gt;5 days). The most commonly reported complications were pneumonia (5.7%), urinary tract infection (9.4%), septic shock (3.8%), superficial incisional infection (5.7%), organ or space infection (5.7%), pulmonary embolism (11.3%), DVT requiring therapy (15.1%) and wound dehiscence (5.7%). CONCLUSION Our study demonstrated the significant influence of clinical variables on prolonged hospitalization of IMSCT patients. This should be factored into clinical and surgical decision making and when counseling patients of their expected outcomes.

Spinal Cord Tumors

Spinal tumors can be broadly classified on the basis of the anatomical compartment they occupy. These tumors can be intramedullary, intradural extramedullary, or extradural. Regardless of location, significant neurologic morbidity can occur as a result of their effects on the spinal cord or the cauda equina, or both. This chapter summarizes the pathophysiologic factors, clinical characteristics, imaging characteristics, and treatment of each tumor type.

Clinical profile, management and surgical outcome of spinal cord tumors

Background: Spinal cord tumors can result in dramatic neurological and functional disabilities in the patients. We aimed to know the incidence of different types of spinal tumors and correlation between clinical presentation and pathological findings and compare outcomes of these tumors postoperatively.Methods: A total of 50 patients were included in the study group. After a thorough clinical evaluation, patients were subjected to a magnetic resonance imaging (MRI) and then surgery. They were described on the basis of age, sex, location of the tumor, type of the tumor, symptoms, histopathological type, surgical resection and complications.Results: Study included 29 males and 21 females and their age ranged from 5 years to 70 years. Out of the 50 patients, 39 had intradural and 11 had extradural spinal tumors. Amongst the 39 intradural tumors, 27 were extramedullary and 12 were intramedullary in location. A predilection towards the thoracic region (44%) was seen followed by the cervical cord. The tumors were excised completely in 68% of the patients while subtotal resection was done in 18% and near total resection in 14% patients. There was significant drop in VAS score and improvement in McCormicks score at 3 months of follow up.Conclusions: Based on this study it could be suggested that surgical excision and decompression should be attempted in all patients of intradural spinal tumor fit to undergo the procedure, as it not only helps in reaching a definitive histopathological diagnosis but also achieves neurological improvement in most patients without causing significant morbidity and mortality.