Our research examines the learning curves of various minimally invasive lumbar surgeries to determine the benefits and challenges they pose to both surgeons and patients. The advent of microsurgical techniques since the 1960s, including advances in fluoroscopic navigation and intraoperative computed tomography, has significantly shifted spinal surgery from open to minimally invasive methods. This study critically evaluates surgical duration, intraoperative conversions to open surgery, and complications as primary parameters to gauge these learning curves. Through a comprehensive literature search up to March 2024, involving databases PubMed, Cochrane Library, and Web of Science, this paper identifies a steep learning curve associated with these surgeries. Despite their proven advantages in reducing recovery time and surgical trauma, these procedures require surgeons to master advanced technology and equipment, which can directly impact patient outcomes. The study underscores the need for well-defined learning curves to facilitate efficient training and enhance surgical proficiency, especially for novice surgeons. Moreover, it addresses the implications of technology on surgical accuracy and the subsequent effects on complication rates, providing insights into the complex dynamics of adopting new surgical innovations in spinal health care.
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Objective To evaluate the impact of H3K27M mutation in the prognosis of histological high-grade intramedullary astrocytoma.
Methods A total of 78 patients who were diagnosed with high-grade spinal cord astrocytoma were included. Clinical data consisting demographic, radiological, molecular features and treatment data were recorded. Univariate and multivariate Cox analysis were performed to investigate variables associated with survival outcome of histological high-grade spinal cord astrocytoma.
Results Median survival time was 21 months. Overall survival (OS) at 1 and 3 years was 65.7% and 40.7%, respectively. Sex, location, and tumor span did not present significant association with OS. Patients with H3K27M mutation showed significant shorter duration of symptom than patients with H3K27 wild-type. As respect to adjuvant treatment, adjuvant radiotherapy and chemotherapy were associated with favorable OS (both p = 0.01). Younger patients (age ≤ 18 years) had shorter OS (p = 0.008) than adult patients (age > 18 years). Of note, H3K27M mutation did not show significant impact on the survival outcome, regardless of histology grade 3 or grade 4 (p = 0.3).
Conclusion Histological high-grade spinal cord astrocytoma has dismal prognosis. Our study demonstrated that H3K27M mutation did not show significant impact on survival outcome of histological high-grade spinal cord astrocytoma.
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Impact of Extent of Resection on Overall Survival in World Health Organization Grade 4 Primary Spinal Cord Astrocytomas Xuanbo Shao, Zhuofan Xu, Penghao Liu, Lei Cheng, Maoyang Qi, Xiang Fang, Yang Feng, Zhenlei Liu, Kai Wang, Jian Guan, Zuowei Wang, Xingwen Wang, Hao Wu, Fengzeng Jian, Zan Chen, Wanru Duan Neurosurgery.2026;[Epub] CrossRef
Preoperative radiotherapy combined with surgery versus surgery alone for primary retroperitoneal sarcoma: a meta-analysis Young Rak Kim, Chang-Hyun Lee, Hangeul Park, Jun-Hoe Kim, Chi Heon Kim Scientific Reports.2025;[Epub] CrossRef
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Objective Long-level intramedullary spinal cord tumors (LIMSCTs) cause complex treatment issues. However, LIMSCTs have rarely been analyzed separately. The authors reported a large case series of LIMSCTs and analyzed the clinical characteristics and treatment outcomes.
Methods The medical data of patients with LIMSCTs at our institution between January 2015 and December 2019 were retrospectively reviewed. Demographics, tumor size and location, pathology, extent of resection, and neurological functional status were collected.
Results A total of 43 consecutive cases were included. Twenty-three cases (53.5%) of LIMSCTs were ependymal tumors. All patients with ependymal tumors achieved gross total resection (GTR). In ependymal tumor cases, 3 cases (13%) of ependymal tumors experienced postoperative neurological deterioration, and 66% of them showed an improvement at follow-up; 25.6% were low-grade astrocytic tumors. The rates of GTR, subtotal resection (STR) and partial resection (PR) were 63.6%, 27.3%, and 9.1%, respectively. Twenty-seven percent cases showed postoperative neurological worsening, and 33% of them had an improvement at follow-up; 20.9% were high-grade astrocytic tumors. The excision rates were 44.4% for GTR, 44.4% for STR, and 11% for PR, respectively. Fifty-five percent cases showed postoperative neurological worsening, and none of them had an improvement at follow-up.
Conclusion In this series, all LIMSCTs were gliomas. Aggressive tumor resection did not increase the risk of long-term functional deterioration in ependymal tumors and low-grade astrocytic tumors, but in high-grade astrocytic tumors, patients had a higher risk of neurological deterioration and difficulty in recovery. In ependymal tumors and low-grade astrocytic tumors, patients can achieve long-time survival after performing aggressive tumor resection.
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Intramedullary Spinal Cord Tumors in the Elderly Patient Max Ward, Ethan D.L. Brown, Apratim Maity, Sheng-Fu Larry Lo, Daniel M. Sciubba Neurosurgery Clinics of North America.2026;[Epub] CrossRef
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Clinical features and surgical outcomes of pediatric long-level intramedullary spinal cord tumors: a single-institution series of 42 cases Yiji Li, Mingquan Liu, Dongao Zhang, Xingang Zhao, Cong Liang, Yinqian Wang, Kun Wu, Zijun Zhao, Ze Ding, Tao Fan Neurosurgical Review.2025;[Epub] CrossRef
Risk factors associated with rapid progression of scoliosis following intraspinal lesion resection in laminoplasty patients Mingquan Liu, Yiji Li, Xingang Zhao, Dongao Zhang, Cong Liang, Yinqian Wang, Kun Wu, Tao Fan Neurosurgical Review.2025;[Epub] CrossRef
Management and Outcome of Recurring Low-Grade Intramedullary Astrocytomas Elly Chaskis, Martina Silvestri, Nozar Aghakhani, Fabrice Parker, Steven Knafo Cancers.2024; 16(13): 2417. CrossRef
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