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Clinical Trial Protocol Editorial

First-in-Human Trial of Photodynamic Therapy for Spinal Cord Malignant Astrocytoma: Study Protocol
Toshiki Endo, Yoshiharu Takahashi, Taketo Nishizawa, Tatsuya Sasaki, Aya Sato, Shinjiro Fukami, Satoshi Miyata, Jiro Akimoto
Neurospine 2024;21(4):1276-1282.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2449272.636

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First-in-Human Trial of Photodynamic Therapy for Spinal Cord Malignant Astrocytoma: Study Protocol
Neurospine. 2024;21(4):1276-1282.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2449272.636
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First-in-Human Trial of Photodynamic Therapy for Spinal Cord Malignant Astrocytoma: Study Protocol
Neurospine. 2024;21(4):1276-1282.   Published online December 31, 2024
DOI: https://doi.org/10.14245/ns.2449272.636
Close
Our extensive basic research on photodynamic therapy (PDT) application in models of intracranial malignant astrocytoma led to its clinical application for intracranial malignant astrocytoma in Japan. Having considered the safety and effectiveness of this pathology, we initiate a first-in-human clinical study of PDT for spinal cord malignant astrocytoma. This study has an open-label, single-arm design. The initial follow-up period is 12 months, at the end of which we will quantify survival after PDT for spinal cord malignant astrocytoma as primary objective. The secondary objective is to quantify the overall progression-free survival of treated patients and the percentage of patients surviving 6 months after PDT without recurrence. Twenty patients suffering from spinal cord malignant astrocytoma will be recruited. In particular, 10 of those should be newly diagnosed World Health Organization grade 4. After obtaining consent, each patient will receive a single intravenous injection of talaporfin sodium (40 mg/m2) 1 day before tumor resection. One day after completing tumor removal, the residual lesion and/or resection cavity will be irradiated using a 664-nm semiconductor laser with a radiation power density of 150 mW/cm2 and a radiation energy density of 27 J/cm2. The procedure will be performed 22–26 hours after talaporfin sodium administration. This study protocol has been reviewed and approved by the Certified Committee in the Japanese Ministry of Health, Labor, and Welfare University Hospital Medical Information Network Clinical Trials Registry (Japan Registry of Clinical Trials number, jRCT2021220040).
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  • 2 Web of Science

Original Articles

Does H3K27M Mutation Impact Survival Outcome of High-Grade Spinal Cord Astrocytoma?
Fan Zhang, Lei Cheng, Ze Ding, Shengxi Wang, Xingang Zhao, Zijun Zhao, Cong Liang, Kun Wu, Dongao Zhang, Yinqian Wang, Tao Fan
Neurospine 2023;20(4):1480-1489.   Published online December 31, 2023
DOI: https://doi.org/10.14245/ns.2346650.325

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Does H3K27M Mutation Impact Survival Outcome of High-Grade Spinal Cord Astrocytoma?
Neurospine. 2023;20(4):1480-1489.   Published online December 31, 2023
DOI: https://doi.org/10.14245/ns.2346650.325
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Does H3K27M Mutation Impact Survival Outcome of High-Grade Spinal Cord Astrocytoma?
Neurospine. 2023;20(4):1480-1489.   Published online December 31, 2023
DOI: https://doi.org/10.14245/ns.2346650.325
Close
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.

Citations

Citations to this article as recorded by  Crossref logo
  • 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
  • Modern treatment of malignant spinal cord astrocytomas: a review article
    Xuanbo Shao, Xiang Fang, Penghao Liu, Yang Feng, Lei Cheng, Zan Chen, Zhuofan Xu, Wanru Duan
    Medical Oncology.2025;[Epub]     CrossRef
  • Genetic Markers and Mutations in Primary Spinal Cord Tumors and Their Impact on Clinical Management
    Rouzbeh Motiei-Langroudi
    Brain Sciences.2025; 15(10): 1028.     CrossRef
  • Advances in Molecular Pathology, Diagnosis and Treatment of Spinal Cord Astrocytomas
    Zijun Zhao, Zihan Song, Zairan Wang, Fan Zhang, Ze Ding, Tao Fan
    Technology in Cancer Research & Treatment.2024;[Epub]     CrossRef
  • 7,096 View
  • 152 Download
  • 5 Web of Science
  • 5 Crossref

NSJ: Spinal Intramedullary Tumor

Clinical Characteristics and Long-term Outcomes of Spinal Pilocytic Astrocytomas: A Multicenter Retrospective Study by the Neurospinal Society of Japan
Jun Muto, Hidetoshi Murata, Seiji Shigekawa, Takafumi Mitsuhara, Daisuke Umebayashi, Ryo Kanematsu, Masahiro Joko, Tatsushi Inoue, Tomoo Inoue, Toshiki Endo, Yuichi Hirose, for the Investigators of Intramedullary Spinal Cord Tumors in the Neurospinal Society of Japan
Neurospine 2023;20(3):774-782.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346450.225

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Clinical Characteristics and Long-term Outcomes of Spinal Pilocytic Astrocytomas: A Multicenter Retrospective Study by the Neurospinal Society of Japan
Neurospine. 2023;20(3):774-782.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346450.225
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Clinical Characteristics and Long-term Outcomes of Spinal Pilocytic Astrocytomas: A Multicenter Retrospective Study by the Neurospinal Society of Japan
Neurospine. 2023;20(3):774-782.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346450.225
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Objective
The characteristics, imaging features, long-term surgical outcomes, and recurrence rates of primary spinal pilocytic astrocytomas (PAs) have not been clarified owing to their rarity and limited reports. Thus, this study aimed to analyze the clinical presentation, radiological features, pathological findings, and long-term outcomes of spinal PAs.
Methods
Eighteen patients with spinal PAs who were surgically treated between 2009 and 2020 at 58 institutions were included in this retrospective multicenter study. Patient data, including demographics, radiographic features, treatment modalities, and long-term outcomes, were evaluated.
Results
Among the 18 consecutive patients identified, 11 were women and 7 were men; the mean age at presentation was 31 years (3–73 years). Most PAs were located eccentrically, were solid or heterogeneous in appearance (cystic and solid), and had unclear margins. Gross total resection (GTR), subtotal resection (STR), partial resection (PR), and biopsy were performed in 28%, 33%, 33%, and 5% of cases, respectively. During a follow-up period of 65 ± 49 months, 4 patients developed a recurrence; however, the recurrence-free survival did not differ significantly between the GTR and non-GTR (STR, PR, and biopsy) groups.
Conclusion
Primary spinal PAs are rare and present as eccentric and intermixed cystic and solid intramedullary cervical tumors. The imaging features of spinal PAs are nonspecific, and a definitive diagnosis requires pathological support. Surgical resection with prevention of neurological deterioration can serve as the first-line treatment; however, the resection rate does not affect recurrence-free survival. Investigation of relevant molecular biomarkers is required to elucidate the regrowth risk and prognostic factors.

Citations

Citations to this article as recorded by  Crossref logo
  • Thoracic intramedullary spinal cord astrocytoma associated with syringomyelia: a case report of gross total resection
    Igin Ginting, Larona Hydravianto, Lukas Widhiyanto
    International Journal of Surgery Case Reports.2026; 138(3): 987.     CrossRef
  • The 4S of spinal astrocytoma: specific location, syrinx, spasticity and score on Modified Mccormick Scale (MMS) predict long term outcomes in patients undergoing surgical resection of intramedullary spinal astrocytomas
    Bhavya Pahwa, Gaurav Singh, Shashank Sharad Kale
    Journal of Neuro-Oncology.2025; 171(1): 131.     CrossRef
  • Current Treatment Outcomes for Intramedullary Spinal Cord Tumors in Japan
    Toshiki Endo, Yoshiharu Takahashi, Taketo Nishizawa, Akira Ito, Tatsuya Sasaki
    Japanese Journal of Neurosurgery.2025; 34(6): 327.     CrossRef
  • The Role of Radiotherapy, Chemotherapy, and Targeted Therapies in Adult Intramedullary Spinal Cord Tumors
    Ines Esparragosa Vazquez, François Ducray
    Cancers.2024; 16(16): 2781.     CrossRef
  • Cervical Pilocytic Astrocytoma Mimicking Spondylotic Myelopathy: A Case Report and Literature Review
    Morgane M Soler-Rico, Lina Daoud, Edward Fomekong
    Cureus.2024;[Epub]     CrossRef
  • The Inside Story of the Multi–center Studies in the Neurospinal Society of Japan
    Keisuke Takai
    Spinal Surgery.2024; 38(2): 105.     CrossRef
  • Current Trends and Future Perspective of Intramedullary Spinal Cord Tumor Treatments
    Toshiki Endo, Yoshiharu Takahashi, Taketo Nishizawa, Tatsuya Sasaki
    Japanese Journal of Neurosurgery.2024; 33(6): 408.     CrossRef
  • 8,395 View
  • 214 Download
  • 3 Web of Science
  • 7 Crossref

NSJ: Spinal Intramedullary Tumor

The Impact of Adjuvant Radiotherapy on Clinical Performance Status in Patients With Grade II Spinal Cord Astrocytoma – A Nationwide Analysis by the Neurospinal Society of Japan
Ryo Kanematsu, Masaki Mizuno, Tomoo Inoue, Toshiyuki Takahashi, Toshiki Endo, Seiji Shigekawa, Jun Muto, Daisuke Umebayashi, Takafumi Mitsuhara, Kazutoshi Hida, Junya Hanakita, for the Investigators of Intramedullary Spinal Cord Tumors in the Neurospinal Society of Japan
Neurospine 2023;20(3):766-773.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346386.193

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The Impact of Adjuvant Radiotherapy on Clinical Performance Status in Patients With Grade II Spinal Cord Astrocytoma – A Nationwide Analysis by the Neurospinal Society of Japan
Neurospine. 2023;20(3):766-773.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346386.193
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The Impact of Adjuvant Radiotherapy on Clinical Performance Status in Patients With Grade II Spinal Cord Astrocytoma – A Nationwide Analysis by the Neurospinal Society of Japan
Neurospine. 2023;20(3):766-773.   Published online September 30, 2023
DOI: https://doi.org/10.14245/ns.2346386.193
Close
Objective
The impact of adjuvant radiotherapy on overall survival (OS) and progression-free survival (PFS) of patients with grade II spinal cord astrocytomas remains controversial. Additionally, the relationship between progression and clinical deterioration after radiotherapy has not been well investigated.
Methods
This study included 53 patients with grade II intramedullary spinal cord astrocytomas treated by either subtotal, partial resection or open biopsy. Their clinical performance status was assessed immediately before operation and 1, 6, 12, 24, and 60 months after surgery by Karnofsky Performance Scale (KPS). Patients with and without adjuvant radiotherapy were compared.
Results
The groups with and without radiation comprised 23 and 30 patients with a mean age of 50.3 ± 22.6 years (range, 2–88 years). The mean overall disease progression rate was 47.1% during a mean follow-up period of 48.4 ± 39.8 months (range, 2.5–144.5 months). In the radiation group, 11 patients (47.8%) presented with progressive disease, whereas 14 patients (46.7%) presented with progressive disease in the group without radiation. There were no significant differences in OS or PFS among patients with or without adjuvant radiotherapy. KPS in both groups, especially radiation group, gradually decreased after operation and deteriorated before the confirmation of disease progression.
Conclusion
Adjuvant radiotherapy did not show effectiveness regarding PFS or OS in patients with grade II spinal cord astrocytoma according to classical classification based on pathohistological findings.

Citations

Citations to this article as recorded by  Crossref logo
  • 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; 37(3): 363.     CrossRef
  • The 4S of spinal astrocytoma: specific location, syrinx, spasticity and score on Modified Mccormick Scale (MMS) predict long term outcomes in patients undergoing surgical resection of intramedullary spinal astrocytomas
    Bhavya Pahwa, Gaurav Singh, Shashank Sharad Kale
    Journal of Neuro-Oncology.2025; 171(1): 131.     CrossRef
  • The impact of adjuvant radiotherapy on overall survival in spinal low-grade gliomas: a propensity score-matched analysis
    Victor Gabriel El-Hajj, Sruthi Ranganathan, Harry Hoang, Abdul Karim Ghaith, Mohamad Bydon, Adrian Elmi-Terander
    Journal of Neuro-Oncology.2025; 171(3): 629.     CrossRef
  • Current Treatment Outcomes for Intramedullary Spinal Cord Tumors in Japan
    Toshiki Endo, Yoshiharu Takahashi, Taketo Nishizawa, Akira Ito, Tatsuya Sasaki
    Japanese Journal of Neurosurgery.2025; 34(6): 327.     CrossRef
  • Molecular insights and the role of 18F-FDG-PET/CT in the diagnosis of spinal gliomas
    Yoshitaka Nagashima, Yusuke Nishimura, Kaoru Eguchi, Junya Yamaguchi, Shoichi Haimoto, Fumiharu Ohka, Kazuya Motomura, Takashi Abe, Mamoru Matsuo, Eisuke Tsukamoto, Masahito Hara, Ryuta Saito
    Acta Neurochirurgica.2024;[Epub]     CrossRef
  • The Role of Radiotherapy, Chemotherapy, and Targeted Therapies in Adult Intramedullary Spinal Cord Tumors
    Ines Esparragosa Vazquez, François Ducray
    Cancers.2024; 16(16): 2781.     CrossRef
  • The Inside Story of the Multi–center Studies in the Neurospinal Society of Japan
    Keisuke Takai
    Spinal Surgery.2024; 38(2): 105.     CrossRef
  • Spinal intramedullary tumors
    Belal Neyazi, Aiden Haghikia, Christian Mawrin, Elke Hattingen, Dirk Vordermark, I. Erol Sandalcioglu
    Deutsches Ärzteblatt international.2024;[Epub]     CrossRef
  • Current Trends and Future Perspective of Intramedullary Spinal Cord Tumor Treatments
    Toshiki Endo, Yoshiharu Takahashi, Taketo Nishizawa, Tatsuya Sasaki
    Japanese Journal of Neurosurgery.2024; 33(6): 408.     CrossRef
  • 5,440 View
  • 196 Download
  • 4 Web of Science
  • 9 Crossref
Detection of Glioma-Related Hotspot Mutations Through Sequencing of Cerebrospinal Fluid (CSF)-Derived Circulating Tumor DNA: A Pilot Study on CSF-Based Liquid Biopsy for Primary Spinal Cord Astrocytoma
Lei Cheng, Wanru Duan, Jian Guan, Kai Wang, Zhenlei Liu, Xingwen Wang, Zuowei Wang, Hao Wu, Zan Chen, Fengzeng Jian
Neurospine 2023;20(2):701-708.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346210.105

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Detection of Glioma-Related Hotspot Mutations Through Sequencing of Cerebrospinal Fluid (CSF)-Derived Circulating Tumor DNA: A Pilot Study on CSF-Based Liquid Biopsy for Primary Spinal Cord Astrocytoma
Neurospine. 2023;20(2):701-708.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346210.105
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Detection of Glioma-Related Hotspot Mutations Through Sequencing of Cerebrospinal Fluid (CSF)-Derived Circulating Tumor DNA: A Pilot Study on CSF-Based Liquid Biopsy for Primary Spinal Cord Astrocytoma
Neurospine. 2023;20(2):701-708.   Published online June 30, 2023
DOI: https://doi.org/10.14245/ns.2346210.105
Close
Objective
Although cerebrospinal fluid (CSF)-based liquid biopsy was proved to be practical in molecular analysis of intracranial gliomas, liquid biopsy of primary intramedullary astrocytoma was rarely reported. Given the distinct genomic profiles between primary intramedullary glioma and intracranial astrocytoma, whether the feasibility of CSF-based molecular analysis of intracranial gliomas can be replicated in primary spinal cord astrocytoma needs to be investigated. The aim of this pilot study is to evaluate the feasibility of molecular analysis of primary intramedullary astrocytoma through sequencing CSF-derived circulating tumor DNA (ctDNA).
Methods
Two grade IV diffuse midline gliomas, 1 grade II, and 1 grade I astrocytoma were included. Intraoperative collection of peripheral blood and CSF samples was conducted, along with postoperative collection of matched tumor tissues. A panel covering the 1,021 most common driver genes of solid tumors was used for targeted DNA sequencing.
Results
CSF-derived ctDNA was detected in 3 CSF samples (2 grade IV diffuse midline gliomas and 1 grade I astrocytoma), 5 mutations were found in both tumor tissues and CSF samples, while 11 mutations and 20 mutations were detected exclusively in tumor tissues and CSF samples, respectively. Importantly, hotspot genetic alterations, including H3F3A K28M, TP53, and ATRX, were identified in CSF and the average mutant allele frequency was often higher in CSF than in tumor tissues.
Conclusion
CSF-based liquid biopsy showed potential feasibility for molecular analysis of primary intramedullary astrocytoma through sequencing of ctDNA. This approach may assist in diagnosis and prognostic evaluation of this rare spinal cord tumor.

Citations

Citations to this article as recorded by  Crossref logo
  • Cell-free DNA from cerebrospinal fluid cytology specimens as a novel liquid biopsy approach for pediatric patients with primary central nervous system tumors
    Nicholas Chun, Brandon Edelbach, Muhammad Baig, Laura A. T. Kagami, Richard A. Robison, Edwina Choung, Isaac Kremsky, Kevin Leeper, Brian Ferguson, D. Gigi Ostrow, Cindy Fong, Udochukwu Oyoyo, Rajeev Nowrangi, Minwoo Song, Bin Othman, Tanya Minasian, Diem
    Acta Neuropathologica Communications.2026;[Epub]     CrossRef
  • The emerging role of circulating tumor DNA in brain tumor research
    Amir Modarresi Chahardehi, Niki Faraji, Nikoo Emtiazi, Reza Nasiri, Maryam Daghagheleh, Helia Mohammadaein, Fatemeh Masoudi, Kimia Ghazi Vakili, Aylin Sefidmouy Azar, Hossein Fatemian, Hossein Motedayyen, Reza Arefnezhad, Fatemeh Rezaei-Tazangi, Zahra Nik
    IBRO Neuroscience Reports.2025; 18: 714.     CrossRef
  • Temporal and spatial variations in CSF pressure are influenced by electrical stimulation of the OCI muscles in beagles
    Xiao-Ying Yuan, Kai-Qi Yang, Yue Ma, Jie Wang, De-Zheng Gong, Dong-Mei Hu, Jing Zhuang, M. Adeel Alam Shah, Sheng-Bo Yu, Hong-Jin Sui
    Scientific Reports.2025;[Epub]     CrossRef
  • Sequencing of cerebrospinal fluid cell-free DNA facilitated early differential diagnosis of intramedullary spinal cord tumors
    Ruichao Chai, Songyuan An, Han Lin, Bo Pang, Hao Yan, Yun Liu, Yilin Wu, Long Wang, Xing Liu, Huiyuan Chen, Xueyu Yang, Qing Chang, Wenqing Jia, Yongzhi Wang
    npj Precision Oncology.2024;[Epub]     CrossRef
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    Maaheen Ahmed, Philip J. Chang, Sean R. Smith
    Current Physical Medicine and Rehabilitation Reports.2024; 12(2): 145.     CrossRef
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    Jin-Hua Liang, Yi-Fan Wu, Hao-Rui Shen, Yue Li, Jun-Heng Liang, Rui Gao, Wei Hua, Chun-Yu Shang, Kai-Xin Du, Tong-Yao Xing, Xin-Yu Zhang, Chen-Xuan Wang, Liu-Qing Zhu, Yang W. Shao, Jian-Yong Li, Jia-Zhu Wu, Hua Yin, Li Wang, Wei Xu
    Leukemia.2024; 38(7): 1541.     CrossRef
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    Victor M. Lu, George I. Jallo, Nir Shimony
    Child's Nervous System.2024; 40(10): 3107.     CrossRef
  • Diagnosis of pediatric central nervous system tumors using methylation profiling of cfDNA from cerebrospinal fluid
    Lotte Cornelli, Ruben Van Paemel, Maísa R. Ferro dos Santos, Sofie Roelandt, Leen Willems, Jelle Vandersteene, Edward Baert, Liselot M. Mus, Nadine Van Roy, Bram De Wilde, Katleen De Preter
    Clinical Epigenetics.2024;[Epub]     CrossRef
  • Biomarkers in Cerebrospinal Fluid for the Diagnosis and Monitoring of Gliomas
    Dimosthenis Papadimitrakis, Miltiadis Perdikakis, Antonios N. Gargalionis, Athanasios G. Papavassiliou
    Biomolecules.2024; 14(7): 801.     CrossRef
  • Morphogenetic Designs, and Disease Models in Central Nervous System Organoids
    Minsung Bock, Sung Jun Hong, Songzi Zhang, Yerin Yu, Somin Lee, Haeeun Shin, Byung Hyune Choi, Inbo Han
    International Journal of Molecular Sciences.2024; 25(14): 7750.     CrossRef
  • Astrocytomas of the spinal cord
    Joerg-Christian Tonn, Nico Teske, Philipp Karschnia
    Neuro-Oncology Advances.2024; 6(Supplement): iii48.     CrossRef
  • 7,123 View
  • 186 Download
  • 12 Web of Science
  • 11 Crossref
Clinical Characteristics and Treatment Outcomes of Long-Level Intramedullary Spinal Cord Tumors: A Consecutive Series of 43 Cases
Dongao Zhang, Tao Fan, Wayne Fan, Xingang Zhao, Cong Liang, Yinqian Wang, Kun Wu
Neurospine 2023;20(1):231-239.   Published online March 31, 2023
DOI: https://doi.org/10.14245/ns.2244648.324

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Clinical Characteristics and Treatment Outcomes of Long-Level Intramedullary Spinal Cord Tumors: A Consecutive Series of 43 Cases
Neurospine. 2023;20(1):231-239.   Published online March 31, 2023
DOI: https://doi.org/10.14245/ns.2244648.324
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Clinical Characteristics and Treatment Outcomes of Long-Level Intramedullary Spinal Cord Tumors: A Consecutive Series of 43 Cases
Neurospine. 2023;20(1):231-239.   Published online March 31, 2023
DOI: https://doi.org/10.14245/ns.2244648.324
Close
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.

Citations

Citations to this article as recorded by  Crossref logo
  • 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
  • Surgical management of spinal metastases originating from thyroid cancer
    Majid Esmaeilzadeh, Harold F. Hounchonou, Jörg Andreas Müller, Frank Bengel, Joachim K. Krauss
    World Journal of Surgical Oncology.2026;[Epub]     CrossRef
  • PRO-QOL after gross total resection of spinal ependymoma: a retrospective study based on 3-year follow-up observations in a single center
    Dingbang Chen, Tianxiang Shao, Haocheng Zhu, Xin Gao, Quan Huang, Xinghai Yang, Qi Jia, Jianru Xiao
    European Spine Journal.2025; 34(2): 665.     CrossRef
  • 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
  • 8,555 View
  • 181 Download
  • 6 Web of Science
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Review Article

Pathological Classification of the Intramedullary Spinal Cord Tumors According to 2021 World Health Organization Classification of Central Nervous System Tumors, a Single-Institute Experience
Sung-Hye Park, Jae Kyung Won, Chi Heon Kim, Ji Hoon Phi, Seung-Ki Kim, Seung Hong Choi, Chun Kee Chung
Neurospine 2022;19(3):780-791.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244196.098

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Pathological Classification of the Intramedullary Spinal Cord Tumors According to 2021 World Health Organization Classification of Central Nervous System Tumors, a Single-Institute Experience
Neurospine. 2022;19(3):780-791.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244196.098
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Pathological Classification of the Intramedullary Spinal Cord Tumors According to 2021 World Health Organization Classification of Central Nervous System Tumors, a Single-Institute Experience
Neurospine. 2022;19(3):780-791.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244196.098
Close
According to the new 2021 World Health Organization (WHO) classification of tumors of the central nervous system (CNS) the classification of the primary intramedullary spinal cord tumors (IM-SCT) follows that of CNS tumors. However, since the genetics and methylation profile of ependymal tumors depend on the location of the tumor, the ‘spinal (SP)’ should be added for the ependymoma (EPN) and subependymoma (SubEPN). For an evidence-based review, the authors reviewed SCTs in the archives of the Seoul National University Hospital over the past decade. The frequent pathologies of primary IM-SCT were SP-EPN (45.1%), hemangioblastoma (20.0%), astrocytic tumors (17.4%, including pilocytic astrocytoma [4.6%] and diffuse midline glioma, H3 K27-altered [4.0%]), myxopapillary EPN (11.0%), and SP-subEPN (3.0%) in decreasing order. IDH-mutant astrocytomas, oligodendrogliomas, glioneuronal tumors, embryonal tumors, and germ cell tumors can occur but are extremely rare in the spinal cord. Genetic studies should support for the primary IM-SCT classification. In the 2021 WHO classifications, extramedullary SCT did not change significantly but contained several new genetically defined types of mesenchymal tumors. This article focused on primary IM-SCT for tumor frequency, age, sex difference, pathological features, and genetic abnormalities, based on a single-institute experience.

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  • 13,264 View
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Original Article

Current Trends in the Surgical Management of Intramedullary Tumors: A Multicenter Study of 1,033 Patients by the Neurospinal Society of Japan
Toshiki Endo, Tomoo Inoue, Masaki Mizuno, Ryu Kurokawa, Kiyoshi Ito, Shigeo Ueda, Toshihiro Takami, Kazutoshi Hida, Minoru Hoshimaru, Investigators of intramedullary spinal cord tumors in the Neurospinal Society of Japan
Neurospine 2022;19(2):441-452.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244156.078

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Current Trends in the Surgical Management of Intramedullary Tumors: A Multicenter Study of 1,033 Patients by the Neurospinal Society of Japan
Neurospine. 2022;19(2):441-452.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244156.078
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Current Trends in the Surgical Management of Intramedullary Tumors: A Multicenter Study of 1,033 Patients by the Neurospinal Society of Japan
Neurospine. 2022;19(2):441-452.   Published online June 30, 2022
DOI: https://doi.org/10.14245/ns.2244156.078
Close
Objective
We performed a retrospective observational study to demonstrate the surgical risks and long-term prognoses of intramedullary tumors in Japan using a multicenter registry authorized by the Neurospinal Society of Japan.
Methods
Data from 1,033 consecutive patients with intramedullary tumors, treated between 2009 and 2020, were collected from 58 centers. Patients with spinal lipomas or myxopapillary ependymomas were excluded. Patient characteristics, clinical presentations, imaging characteristics, treatments, and outcomes were analyzed. The modified McCormick scale was used to classify functional status. Survival was described using Kaplan-Meier curves, and multivariable logistic regression analyses were performed.
Results
The mean age of the patients was 48.4 years. Data of 361 ependymomas, 196 hemangioblastomas, 168 astrocytic tumors, 160 cavernous malformations, and the remaining 126 cases including subependymomas, metastases, schwannomas, capillary hemangiomas, and intravascular B-cell lymphomas were analyzed. Twenty-two patients were undiagnosed. The mean follow-up duration was 46.1 ± 38.5 months. Gross total tumor removal was achieved in 672 tumors (65.1%). On the modified McCormick scale, 234 patients (22.7%) had worse postoperative grades at the time of discharge. However, neurological status gradually improved. At 6 months postoperatively, 251 (27.5%), 500 (54.9%), and 160 patients (17.6%) had improved, unchanged, and worsened grades, respectively. Preoperative functional status, gross total tumor removal, and histopathological type were significantly associated with mortality and functional outcomes.
Conclusion
Our findings demonstrate better postoperative functional outcomes in patients with fewer preoperative neurological deficits. Degree of resection, postoperative treatments, and prognoses are closely related to the histology of intramedullary tumors.

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  • 316 Download
  • 36 Web of Science
  • 39 Crossref

Review Article

Recent Molecular and Genetic Findings in Intramedullary Spinal Cord Tumors
Yoshitaka Nagashima, Yusuke Nishimura, Kaoru Eguchi, Junya Yamaguchi, Shoichi Haimoto, Fumiharu Ohka, Masakazu Takayasu, Ryuta Saito
Neurospine 2022;19(2):262-271.   Published online May 16, 2022
DOI: https://doi.org/10.14245/ns.2244168.084

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Recent Molecular and Genetic Findings in Intramedullary Spinal Cord Tumors
Neurospine. 2022;19(2):262-271.   Published online May 16, 2022
DOI: https://doi.org/10.14245/ns.2244168.084
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Recent Molecular and Genetic Findings in Intramedullary Spinal Cord Tumors
Neurospine. 2022;19(2):262-271.   Published online May 16, 2022
DOI: https://doi.org/10.14245/ns.2244168.084
Close
The study of genetic alterations and molecular biology in central nervous system (CNS) tumors has improved the accuracy of estimations of patient prognosis and tumor categorization. Therefore, the updated 2021 World Health Organization (WHO) classification includes various diagnostic genes, molecules, and pathways for diagnosis, as well as histological findings. These findings are expected both to have diagnostic applications and to facilitate new targeted therapies that target tumor-specific genetic changes and molecular biology. Intramedullary spinal cord tumors (IMSCTs) are rare CNS tumors that are difficult to treat because they occur in eloquent areas. Although the genetic underpinnings of IMSCTs remain unclear compared to their intracranial counterparts, the genetic characteristics of these tumors are gradually being revealed. Here, we describe the major changes in the new 2021 WHO classification and review the major types of IMSCTs, with an emphasis on their clinical features and genetic alterations.

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  • Clinical Characteristics and Treatment Outcomes of Long-Level Intramedullary Spinal Cord Tumors: A Consecutive Series of 43 Cases
    Dongao Zhang, Tao Fan, Wayne Fan, Xingang Zhao, Cong Liang, Yinqian Wang, Kun Wu
    Neurospine.2023; 20(1): 231.     CrossRef
  • The Impact of Adjuvant Radiotherapy on Clinical Performance Status in Patients With Grade II Spinal Cord Astrocytoma – A Nationwide Analysis by the Neurospinal Society of Japan
    Ryo Kanematsu, Masaki Mizuno, Tomoo Inoue, Toshiyuki Takahashi, Toshiki Endo, Seiji Shigekawa, Jun Muto, Daisuke Umebayashi, Takafumi Mitsuhara, Kazutoshi Hida, Junya Hanakita
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  • Magnetic Resonance Imaging Scans of Cervical Spinal Cord Ependymoma with Changing Radiological Features over a Short Period of Time
    Yoshitaka Nagashima, Yusuke Nishimura, Ryuta Saito
    World Neurosurgery.2022; 167: 95.     CrossRef
  • 12,572 View
  • 290 Download
  • 16 Web of Science
  • 17 Crossref

Original Article

Spine and Spinal Cord Tumors DSPN-Neurospine Special Issue

Intramedullary Spinal Cord Lesions: A Single-Center Experience
Vincent Jecko, Paul Roblot, Lorenzo Mongardi, Morgan Ollivier, Natalia Delgado Piccoli, Thomas Charleux, Thomas Wavasseur, Edouard Gimbert, Dominique Liguoro, Guillaume Chotard, Jean-Rodolphe Vignes
Neurospine 2022;19(1):108-117.   Published online March 31, 2022
DOI: https://doi.org/10.14245/ns.2143190.595

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Intramedullary Spinal Cord Lesions: A Single-Center Experience
Neurospine. 2022;19(1):108-117.   Published online March 31, 2022
DOI: https://doi.org/10.14245/ns.2143190.595
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Intramedullary Spinal Cord Lesions: A Single-Center Experience
Neurospine. 2022;19(1):108-117.   Published online March 31, 2022
DOI: https://doi.org/10.14245/ns.2143190.595
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Objective
Spinal cord tumors constitute a small part of spinal surgery owing to their rarity. This retrospective study describes their current management.
Methods
Forty-eight patients were treated for an intramedullary tumor between 2014 and 2020 at a single institution. Patients’ files were retrospectively studied. We detailed clinical status according to neurological deficit and ambulatory ability using the modified McCormick Scale, radiological features like number of levels, associated syringomyelia, surgical technique with or without intraoperative electrophysiological monitoring, pathological findings, and postoperative outcome.
Results
The median age of this population was 43 years, including 5 patients under 18 years. The median delay before first neurosurgical contact was 3 months after the first clinical complaint. Treatment was gross total resection in 43.8%, subtotal resection in 50.0%, and biopsy in 6.2%. A laminectomy was performed for all the patients except 2 operated using the laminoplasty technique. Pathological findings were ependymoma in 43.8%, hemangioblastoma in 20.8%, and pilocytic astrocytoma in 10.4%. Six patients were reoperated for a tumor recurrence less than 2 years after the first surgical resection. One patient was reoperated for a postoperative cervical kyphosis.
Conclusion
Intramedullary tumors are still a challenging disease and they are treated by various surgical techniques. They must be managed in a specialized center including a trained surgical, radiological, electrophysiological, and pathological team. Arthrodesis must be discussed before performing extensive laminectomy to avoid postoperative kyphosis.

Citations

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  • Prognosis and strategies for reoperation in recurrent spinal tumors: an average 5-Year follow-up retrospective study
    Wei Gao, Zhao-Wen Gu, Qi-Xuan Jiang, Chi Gu, Jing-Yin Chen, Ai-Qin Chen, Guang-Yu Ying, Yong-Jian Zhu, Qiang-Wei Wang
    European Spine Journal.2026; 35(2): 772.     CrossRef
  • Spinal Cord Deformities Associated with Intramedullary Spinal Cord Tumors
    Forrest Hamrick, Rajiv R. Iyer
    Neurosurgery Clinics of North America.2026;[Epub]     CrossRef
  • Survival and Functional Outcomes Following Surgical Resection of Intramedullary Spinal Cord Tumors: A Series of 253 Patients over 22 Years
    Abdel-Hameed Al-Mistarehi, Khaled J. Zaitoun, Sania Javed, Yuanxuan Xia, Andrew Hersh, Abdul Karim Ghaith, Carly Weber-Levine, Kelly Jiang, Majid Khan, Benjamin Mendelson, Noa Ksabi, Daniel M. Sciubba, Ziya L. Gokaslan, George I. Jallo, Jean-Paul Wolinsky
    Cancers.2025; 17(13): 2112.     CrossRef
  • Intraoperative Neurophysiologic Monitoring and Mapping During Surgery on Intramedullary Spinal Cord Tumors in Children and Adolescents
    Kathleen Seidel, Vedran Deletis, Andreas Raabe, Katharina Lutz, Philippe Schucht
    Journal of Clinical Neurophysiology.2024; 41(2): 116.     CrossRef
  • The application value and improved warning criterion of D-wave monitoring in intramedullary spinal cord tumor surgery
    Ke Li, Xiaorong Tao, Jiajia Liu, Jun Yang, Jiawei Shi, Xiao Wu, Wenqing Jia, Xing Fan, Hui Qiao
    The Spine Journal.2024; 24(9): 1704.     CrossRef
  • A comprehensive evaluation of imaging features in pediatric spinal gliomas and their value in predicting tumor grade and histology
    Carmen Rosa Cerron-Vela, Fabrício Guimarães Gonçalves, Luis Octavio Tierradentro-García, Angela N Viaene, Wondwossen Lerebo, Savvas Andronikou
    Neuroradiology.2024; 66(8): 1311.     CrossRef
  • A Concise Guide to D-Wave Monitoring during Intramedullary Spinal Cord Tumour Surgery
    Santos Nicolás Zurita Perea, Pablo Abel Alvarez Abut, Kathleen Seidel
    Medicina.2024; 60(8): 1242.     CrossRef
  • Concurrent Oncolysis and Neurolesion Repair by Dual Gene-Engineered hNSCs in an Experimental Model of Intraspinal Cord Glioblastoma
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    Jiro Akimoto, Shinjiro Fukami, Kenta Nagai, Michihiro Kohno
    Journal of Clinical Medicine.2023; 12(2): 432.     CrossRef
  • Clinical Characteristics and Treatment Outcomes of Long-Level Intramedullary Spinal Cord Tumors: A Consecutive Series of 43 Cases
    Dongao Zhang, Tao Fan, Wayne Fan, Xingang Zhao, Cong Liang, Yinqian Wang, Kun Wu
    Neurospine.2023; 20(1): 231.     CrossRef
  • Predictors for spinal deformity following resection of intramedullary tumor via posterior approach: a systematic review and meta-analysis
    Maciej Szyduczyński, Johannes Korneliussen, Oscar Landé, Michał Krakowiak, Tomasz Szmuda, Grzegorz Miękisiak
    European Spine Journal.2023; 32(12): 4355.     CrossRef
  • Diagnosis and Surgical Treatment Methods of Intraspinal Tumors and Their Postoperative Impact
    入元 胡
    Advances in Clinical Medicine.2023; 13(09): 13999.     CrossRef
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    Neurospine.2023; 20(3): 756.     CrossRef
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    Manuel Cunha e Sá
    Acta Neurochirurgica.2022; 164(10): 2623.     CrossRef
  • 13,415 View
  • 282 Download
  • 13 Web of Science
  • 14 Crossref

Case Report

Primary Spinal Cord Astrocytoma Presenting as Intracranial Hypertension: A Case Report
Sungryong Lim, Seung Joo Lee, Seung Chul Rhim
Korean J Spine 2012;9(3):272-274.   Published online September 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.3.272

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Primary Spinal Cord Astrocytoma Presenting as Intracranial Hypertension: A Case Report
Korean J Spine. 2012;9(3):272-274.   Published online September 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.3.272
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Primary Spinal Cord Astrocytoma Presenting as Intracranial Hypertension: A Case Report
Korean J Spine. 2012;9(3):272-274.   Published online September 30, 2012
DOI: https://doi.org/10.14245/kjs.2012.9.3.272
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Increased intracranial pressure (IICP) is rarely seen in association with primary spinal tumors. We describe a 58-year-old man who was diagnosed with a primary spinal cord astrocytoma, who first presented with hypesthesia, followed by intracranial hypertension, papilledema and blurred vision. On first admission, he presented with hypesthesia but without paraparesis, headache or blurred vision. Spinal MRI showed a relatively well-enhanced solid mass with a cystic portion at the cervico-thoracic level, shown histologically to be a grade I pilocytic astrocytoma. After gross total resection of the tumor, the patient had no significant neurological changes. Nine months later, the patient was admitted with headache, blurred vision and paraparesis. An ophthalmologic examination showed papilledema and lumbar tapping revealed IICP. A spinal MRI showed recurrence of the tumor which was found to be a glioblastoma after reexplorative debulking surgery. After resection, his headaches and blurred vision improved, but his paraparesis did not. These findings show that a primary spinal cord astrocytoma may cause IICP.

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  • 7,835 View
  • 51 Download
  • 7 Crossref
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