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
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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Spinal extradural cavernous angiomas(CAs) are apparently rare lesions. The author report a 67 year old man with an epidural CA at T9-10 space presenting with progressive leg weakness. Magnetic resonance imaging showed a thoracic epidural lesion appearing as isointense on T1-weighted with strong contrast enhancement and hyperintense on T2-weighted images. A moderate hyperdensity and foraminal widening was found on computed tomography. Hemilaminectomy was performed to relieve the spinal cord compression. A highly vascular tumor without bony involvement was observed in the epidural space. Histopathology of the lesion revealed a typical CA.
The patient's symptoms resolved after treatment. Clinical aspect, radiological features, and surgical treatment of this rare entity will be reviewed.
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