Pediatric intramedullary spinal cord tumors - Critical review of the literature

The objective of this review was to analyze the literature on the managemen t of intramedullary spinal cord tumors to determine whether enough informat ion was available for treatment guidelines to be established. Using standar d computerized search techniques, databases containing medical literature w ere queried for keywords related to intramedullary spinal cord tumors, begi nning in 1966. Of the 445 articles published in English and with potential relevance, only 75 articles were included in the final analyses. Based on t he strength of their recommendations for the treatment of this controversia l condition, articles were divided into class I, class II and class III dat a. There were no class I studies related to any aspect of the treatment of intramedullary spinal cord tumors. Based on this critical review of literat ure, gross total removal of an ependymoma confirmed by immediate postoperat ive magnetic resonance imaging and adjunctive treatment for high-grade tumo rs using radiotherapy, with or without chemotherapy, can be recommended as standards of therapy. With the strength of a guideline, radiotherapy should be withheld after gross total removal of intramedullary ependymomas and ra dical resection of low-grade intramedullary astrocytomas. The use of intrao perative ultrasonography and evoked potentials, important surgical adjuncts , can also be considered guidelines. The radical resection of intramedullar y low-grade astrocytomas is an option.