Background Several uncertainties remain concerning the management of intramedullary spinal cord tumours (IMSCTs). These include the timing and extent of resection, its interrelated functional outcome, and the adequate use and timing of radiation therapy and/or chemotherapy. In this retrospective study we report on all adult cases involving IMSCTs treated from 1987 to 2007 in our institution to validate our treatment strategy for IMSCTs. Pre- and post-operative functional performance was classified according to the McCormick scale. Results A total of 70 adult cases with IMSCTs consisting of ependymoma (39), astrocytoma (11), carcinoma metastasis (8), haemangioblastoma (5), cavernoma (3) and others (4) were reviewed. Mean age was 46.8 years (range, 18-79 years), and mean follow-up was 4.5 years (range, 1-195 months). The proportion of localisation in descending order was thoracic (36%), cervical (33%), cervicothoracic (19%) and conus region (13%), with 45 gross total resections, 22 partial resections and three biopsies. Surgery-related morbidity with worsening postoperative symptoms occurred immediately in 13 patients (18.6%). The preoperative McCormick grade correlated significantly with the early postoperative grade and the grade at follow-up (χ2-test; p?=?0.001). None of the patients with preserved intraoperative evoked potentials exhibited significant postoperative deterioration. The degree of resection was correlated with progression-free survival (Duncan test; p?=?0.05). Most patients with malignant tumours, namely anaplastic ependymoma (3), astrocytoma (2) or metastatic lesions (5), underwent postoperative radiation therapy. Six patients (one anaplastic ependymoma, two anaplastic astrocytomas and three metastatic lesions) received postoperative chemotherapy. Conclusions IMSCTs should be operated on when symptoms are mild. We recommend evoked potential-guided microsurgical total resection of ependymomas and other benign lesions; partial resection or biopsy followed by adjuvant therapy should be confined to patients with high-grade astrocytomas, whereas resection or biopsy with adjuvant therapy is the best option for metastatic lesions.
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机译：背景技术关于髓内脊髓肿瘤（IMSCT）的治疗仍存在一些不确定性。这些包括切除的时机和程度，其相关的功能结果以及放疗和/或化学疗法的适当使用和时机。在这项回顾性研究中，我们报告了我们机构从1987年至2007年治疗的所有涉及IMSCT的成人病例，以验证我们针对IMSCT的治疗策略。手术前后的功能表现根据麦考密克量表进行分类。结果回顾了70例成人IMSCT，包括室管膜瘤（39），星形细胞瘤（11），癌转移（8），血管母细胞瘤（5），海绵体瘤（3）和其他（4）。平均年龄为46.8岁（范围18-79岁），平均随访时间为4.5年（范围1-195个月）。局部切除的比例为胸腔（36％），颈椎（33％），颈胸腔（19％）和圆锥体区域（13％），总共切除45例，部分切除22例，活检3例。 13名患者（18.6％）立即发生了与手术相关的并发症，术后症状恶化。术前McCormick评分与术后早期评分和随访时评分显着相关（χ 2 -test; p = 0.001）。保留术中诱发电位的患者均无术后明显恶化。切除程度与无进展生存期相关（Duncan检验; p = 0.05）。大多数恶性肿瘤，即间变性性室管膜瘤（3），星形细胞瘤（2）或转移性病变（5），都接受了术后放射治疗。术后接受化学疗法的患者为6例（1个间变性室间隔瘤，2个间变性星形细胞瘤和3个转移性病变）。结论症状轻微时应进行IMSCT。我们建议对室间隔膜瘤和其他良性病变进行诱发电位的显微外科全切术。部分切除或活检伴随辅助治疗应仅限于高度星形细胞瘤患者，而切除或活检辅助治疗是转移性病变的最佳选择。
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