Abstract
Intramedullary spinal cord astrocytomas are uncommon tumors. They are the most common spinal cord tumor in children and in adults are second only to ependymomas in frequency of occurrence. Low-grade histology predominates with high-grade lesions comprising only ten to fifteen percent of pediatric tumors and a slightly higher proportion in adults. Presenting symptoms typically evolve over months to years with regional back pain the most commonly reported initial complaint. Malignant tumors produce rapid neurological deterioration. MRI is the diagnostic modality of choice: spinal cord astrocytomas are iso- to slightly hypointense on T1, hyperintense on T2 and commonly have associated cysts. They enhance less intensely and are more eccentric than ependymomas. The goals of surgical intervention are to obtain a tissue diagnosis and resect as much tumor as possible without adversely affecting neurological function. Astrocytomas are infiltrating neoplasms and total resection is not generally possible. Somatosensory and motor evoked potential monitoring are routinely used but it is unclear if they improve outcomes. The operating microscope and bipolar cautery are essential surgical tools; the ultrasound and ultrasonic surgical aspirator are useful surgical adjuncts. Laminectomy is performed on adults while laminoplasty is favored for pediatric patients. Outcome for low-grade astrocytomas is less favorable than that of ependymomas with regard to both recurrence and function though many have prolonged survival. There is no correlation of extent of resection and recurrence. Outcome for high-grade tumors is extremely poor; tumor progression is relentless; median survival is thirteen months in children and six months in adults.
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Reimer R, Onofrio BM: Astrocytomas of the spinal cord in children and adolescents. J Neurosurg 63: 669-675, 1985
Fischer G, Brotchi J, Chignier G, Liard A, Zomosa G, Menei P, Hallacq P: Epidemiology. In: Fischer G, Brotchi J (eds) Intramedullary Spinal Cord Tumors. Thieme, Stuttgart, 1996, pp 9-10
Minehan KJ, Shaw EG, Scheithauer BW, Davis DL, Onofrio BM: Spinal cord astrocytoma: pathological and treatment considerations. J Neurosurg 83: 590-595, 1995
Fischer G, Brotchi J, Chignier A, Liard G, Zomosa G, Menei P, Hallacq P: Clinical Material. In: Fischer G, Brotchi J (eds) Intramedullary Spinal Cord Tumors. Thieme, Stuttgart, 1996, pp 10-20
Lee M, Rezai AR, Freed BS, Epstein F: Intramedullary spinal cord tumors in neurofibromatosis. Neurosurgery 38: 32-7, 1996
Epstein F, Epstein N: Surgical management of holocord intramedullary spinal cord astrocytomas in children. J Neurosurg 54: 829-832, 1981
Allen JCAS, Yates AJ, Boyett JM, Cherlow JM, Turski PA, Epstein FJ, Findlay JL: Children's Cancer Group: Treatment of high grade spinal cord astrocytoma of childhood with '8-in-I' chemotherapy and radiotherapy: a pilot study of CCC-945. J Neurosurg 88: 215-220, 1998
McCormick PC, Stein BM: Intramedullary tumors in adults. Neurosurg Clin North Am 1: 687-700, 1990
Fischer G, Brotchi J: Intramedullary Spinal Cord Tumors. Thieme, Stuttgart, 1996, pp 72-81
Epstein FJ, Farmer JP, Freed D: Adult intramedullary astrocytomas of the spinal cord. J Neurosurg 77: 355-359, 1992
Constantini S, Epstein FJ: Intraspinal tumors in infants and children. In: Youmans J (ed) Neurological Surgery. Vol. 4, 4th edn., WE Saunders, Philadelphia, 1996, pp 3123-3133
Cohen AR, Wisoff JH, Allen JC, Epstein F: Malignant astrocytomas of the spinal cord. J Neurosurg 70: 50-54, 1989
Osborn AG: Diagnostic Neuroradiology. Mosby, St. Louis, 1994, pp 906-914
Kearse LA, Jr, Lopez-Bresnahan M, McPeck K, Tambe V: Loss of somatosensory evoked potentials during intramedullary spinal cord surgery predicts postoperative neurologic deficits in motor function (corrected) (published erratum appears in J Clin Anesth 1993 Nov-Dec; 5(6): 529). J Clin Anesth 5: 392-398, 1993
Adams DC, Emerson RG, Heyer FJ, McCormick PC, Carmel PW, Stein BM, Farcy JP, Gallo EJ: Monitoring of intraoperative motor-evoked potentials under conditions of controlled neuromuscular blockade (see comments). Anesth Analg 77: 913-918, 1993
Schramm J: The role of motor evoked potentials during surgery for intramedullary spinal cord tumors (Comment). Neurosurgery 41: 1336, 1997
Epstein FJ, Farmer JP, Schneider SJ: Intraoperative ultrasonography: an important surgical adjunct for intramedullary tumors. J Neurosurg 74: 729-733, 1991
Inoue A, Ikata T, Katoh S: Spinal deformity following surgery for spinal cord tumors and tumorous lesions: analysis based on an assessment of the spinal functional curve. Spinal Cord 34: 536-542, 1996
Cooper PR: Outcome after operative treatment of intramedullary spinal cord tumors in adults: intermediate and long-term results in 51 patients. Neurosurgery 25: 855-859, 1989
Sandler HM, Papadopoulos SM, Thornton AF, Jr, Ross DA: Spinal cord astrocytomas: results of therapy (see comments). Neurosurgery 30: 490-493, 1992
Brotchi J, Fischer G: Intramedullary Spinal Cord Tumors. Thieme, Stuttgart, 1996, pp 60-84
Zide BM, Wisoff JH. Epstein FJ: Closure of extensive and complicated laminectomy wounds. Operative technique. J Neurosurg 67: 59-64, 1987
Samii M, Klekamp J: Surgical results of 100 intramedullary tumors in relation to accompanying syringomyelia. Neurosurgery 35: 865-873; discussion 873, 1994
Hardison HH, Packer RJ, Rorke LB, Schut L, Sutton LN, Bruce DA: Outcome of children with primary intramedullary spinal cord tumors. Childs Nerv Syst 3: 89-92, 1987
Innocenzi C, Salvati M, Cervoni L, Delfini R, Cantore C: Prognostic factors in intramedullary astrocytoma. Clin Neurol Neurosurg 99: 1-5, 1997
Epstein F: Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity (comment). Neurosurgery 35: 76, 1994
Cristante LHH: Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery 35: 69-76, 1994
Brotchi J, Dewitte O, Levivier M, Baleriaux D, Vandesteene A, Raftopoulos C, Flament-Durand J, Noterman J: A survey of 65 tumors within the spinal cord: surgical results and the importance of preoperative magnetic resonance imaging. Neurosurgery 29: 651-656; discussion 656-657, 1991
Kothbauer K, Deletis V, Epstein FJ: Intraoperative spinal cord monitoring for intramedullary surgery: an essential adjunct. Pediatr Neurosurg 26: 247-254, 1997
Merchant TE, Nguyen D, Thompson SJ, Reardon DA, Kun LE, Sanford RA: High-grade pediatric spinal cord tumors (in process citation). Pediatr Neurosurg 30: 1-5, 1999
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Houten, J.K., Cooper, P.R. Spinal Cord Astrocytomas: Presentation, Management and Outcome. J Neurooncol 47, 219–224 (2000). https://doi.org/10.1023/A:1006466422143
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DOI: https://doi.org/10.1023/A:1006466422143