SURGICAL-MANAGEMENT OF INTRAMEDULLARY SPINAL-CORD TUMORS - FUNCTIONAL OUTCOME AND SOURCES OF MORBIDITY

We are reporting the functional outcome of 69 of 86 patients affected by intramedullary spinal cord tumors who underwent surgery at our department during the period of 1984 to 1992. The results on 17 patients affected by hemangioblastomas and cavernomas were excluded from this study and will be published separately. Twenty-eight patients had astrocytic processes; 34 had ependymoma; 4 had lipoma; 2 had neurofibroma; and 1 had oligodendroglioma. The overall rate of ''radically'' resected tumors was 55.1%, as opposed to 17.4% ''quasiradically,'' and 27.5 % of ''partially'' resected processes. There was one postoperative death. Five other patients, affected by anaplastic astrocytomas, died because of tumor progress within 16 months from the operation. A postoperative functional assessment showed that the function of the upper and lower extremities had deteriorated in 65.4 and 55.1% of the patients; a respective functional deterioration by 1 degree of the scale of Cooper and Epstein was registered in 88.8 and 86.8% of the patients. The patients who recovered improved within a period of 6 to 18 months, whereas the function of the dorsal columns was impaired the longest. At follow-up (mean, 54 mo; range, 8-107 mo), the functional recovery (as compared with the preoperative status) was as follows: upper extremity, 17.1% of the patients were improved, 55.5% were unchanged, and 31.5% were worse (89.4% by 1 degree); lower extremity, 22.4% of the patients were improved, 51.5% were unchanged, and 29.4% were worse (most by 1 degree). Surgery on tumors of the cervicothoracic and upper thoracic region carried a relatively higher morbidity in this series. Radical and quasiradical resections were not affected by a higher morbidity than the partial ones. Tumors with large solid components had more pronounced postoperative sensory disturbances; their recovery, although satisfactory, was delayed, En bloc plastic laminotomies seem helpful in preventing postoperative spinal deformities.