AGGRESSIVE, SURGERY FOR INTRAMEDULLARY TUMOR OF CERVICAL SPINAL-CORD

BACKGROUND Intramedullary tumors of the cervical spinal cord are commo n and many believe they are amenable to an aggressive approach. Howeve r, surgical removal of intramedullary tumors of the cervical spinal co rd is still controversial because of the great risk of respiratory dys function or quadriplegia or both upon resection of the tumor. METHODS We present a consecutive series of 58 patients who underwent surgical treatment for intramedullary tumors of the cervical spinal cord. Surgi cal results are analyzed to refine our indications for surgery and its timing. The roles of preoperative radiotherapy and posttherapeutic co rd appearance and function are discussed. RESULTS Tumors were totally resected in 50 (86.2%), subtotally in seven and partially in one patie nt. Forty-five (77.6%) patients had improved neurologic status postope ratively. Intramedullary tumors in the cervical area have better resul ts from surgery than intramedullary tumors in other levels of the spin e. Patients with moderate neurologic deficits can recover remarkably w ell after total tumor removal. Laser surgery is especially helpful for lipoma. Preoperative radiotherapy should be avoided because it is ass ociated with difficult surgery and poor clinical outcome. The thin spi nal cord can function surprisingly well. CONCLUSIONS We conclude that intramedullary tumors of the cervical spinal cord are amenable to tota l surgical removal. Surgery is suitable when a patient presents with a moderate neurologic deficit. Proficient surgical technique for total tumor resection is necessary for good results. Preoperative radiothera py contributes to difficult surgery and poor prognosis, and is not rec ommended.