Intradural Intramedullary Spinal Tumors

Intramedullary spinal cord tumors (IMSCT) are rare neoplasms, both low-grade/slow-growing and truly malignant lesions leading to disabling morbidity. Radical surgery with intraoperative neurophysiology monitoring and image-guided techniques such as intraoperative echography is the gold-standard treatment, even if challenging. Adjuvant radiotherapy and/or chemotherapy are recommended in malignant tumors or when gross total resection is not achievable. Methods: We performed a 14-year prospective analysis of a large group of patients, harboring IMSCT, surgically treated at our institution and reviewed, in comparison, the major surgical series in literature. Results: In our series, 60 patients harboring 63 IMSCTs were treated; 36 ependymomas, 10 astrocytomas, 11 hemangioblastomas, 3 gangliocytomas, 2 lipomas and 1 intramedullary melanotic lesion. Gross total resection was achieved in 79.3% of patients. Up to 50% of the patients improved (mRS score ≤ 2) after surgical resection, mostly in the first six months, at a mean follow-up of 48 months. Conclusions: Skilled surgery plays a crucial role in the treatment of IMSCT. Gross total resection is the major predictor of survival as pre-operative neurologic dysfunction is the major predictor of long-term functional outcome.