Radical microsurgical treatment of intramedullary spinal cord tumors

BACKGROUND: The surgical treatment of intramedullary spinal cord tumor aims at complete removal and minimal postoperative deficit. This study was undertaken to evaluate the microsurgical features of intramedullary spinal cord tumors and the time for surgery and prognosis. METHODS: Twenty-one patients with intramedullary spinal cord tumor who had been treated at Nanfang Hospital, Guangzhou, China since 2000 were studied retrospectively. Fifteen patients were men and 6 women, aged 2 - 60 years (mean 29.28 years). Thirteen patients had the tumor in the cervical segments, 4 in medulla-cervical segments, 1 in cervicothoracic segment, and 3 in thoracic spine. All the patients underwent microsurgery for the tumor through posterior approaches by laminectomy. The tumor was exposed through dorsal myelotomy, then tumor plane was removed carefully from the entire rostrocaudal area. The dura was sutured routinely. In case of tumors occupying too many spinal segments, titanium strip was applied to reconstruct the vertebral plate and keep the spinal column stable. All the patients were subjected to MR imaging early after operation. RESULTS: Complete removal of the tumor was made in 15 patients, subtotal removal in 5, and partial resection in 1. Neurological recovery was related primarily to preoperative neurological conditions of the patients. Patients with minor neurological deficit showed stable sensory and motor function or minor loss in the early postoperative period, and neurological function tended to improve with time. But those with significant or long-standing deficit could hardly demonstrate any recovery. The dissection interface between the tumor and normal cord tissue was the most important factor influencing the extent of surgical removal. CONCLUSIONS: Intramedullary spinal cord tumor mostly take place in cervical segments, with glioma as the commonest type. Microsurgery is the major treatment of choice, by which tumor plane could be totally resected. Excellent microsurgical expertise and careful recognition of tumor plane are essential to removal of the tumor while retaining neurological functions. Titanium strip fixation is helpful to reconstruct vertebral stability. Preoperative neurological conditions of patients are directly related to their postoperative recovery. We underscore the importance of early diagnosis and radical microsurgical treatment of intramedullary spinal cord tumor.