Microsurgical treatment of intramedullary spinal cord tumor

The clinical characteristics, diagnostic imaging by MRI, histological diagnosis, and clinical outcome of intramedullary spinal cord tumors were investigated, and problems in diagnosis and treatment were assessed. The subjects were 45 patients surgically treated for intramedullary spinal cord tumors between 1983 and 2000 (males 25, females 20; age 2-80 years; ependymoma in 11, astrocytoma in 11, hemangioma in 7, schwannoma in 4, hemangioblastoma in 3, ganglioma in 2, others in 7). Radiotherapy had been used in combination to treat 7 astrocytomas and 1 glioblastoma. Numbness was the initial symptom in many of the patients with ependymoma and hemangioma, and dyskinesia was the initial symptom in many of the astrocytoma patients. The duration of morbidity was significantly shorter in the astrocytoma and hemangioma patients than in the ependymoma patients. These results were useful for qualitative diagnosis. Preoperative MRI was performed in 24 patients. The rate of diagnosis by MRI was 37.5%, and the rate of agreement with the intra- and post-operative histological diagnosis was 58.1%. Some of the cases were difficult to diagnose, and as a result the diagnostic rate was low. The ependymomas and vascular tumors were able to be completely removed by surgery, and the surgical outcome was good in those patients, with no deterioration of motor function. None of the astrocytoma patients improved, and 6 ≥ grade II patients died an average of 14.2 months postoperatively. Diagnosis and treatment with close cooperation between radiologists and pathologists as well as progress in surgical technique appeared to be important in improving diagnosis and treatment outcome. (K.H.)