SURGICAL-MANAGEMENT OF INTRAMEDULLARY SPINAL-CORD TUMORS - FUNCTIONALOUTCOME 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 depa rtment during the period of 1984 to 1992. The results on 17 patients a ffected by hemangioblastomas and cavernomas were excluded from this st udy and will be published separately. Twenty-eight patients had astroc ytic processes; 34 had ependymoma; 4 had lipoma; 2 had neurofibroma; a nd 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 becau se of tumor progress within 16 months from the operation. A postoperat ive functional assessment showed that the function of the upper and lo wer 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 pat ients who recovered improved within a period of 6 to 18 months, wherea s the function of the dorsal columns was impaired the longest. At foll ow-up (mean, 54 mo; range, 8-107 mo), the functional recovery (as comp ared with the preoperative status) was as follows: upper extremity, 17 .1% of the patients were improved, 55.5% were unchanged, and 31.5% wer e worse (89.4% by 1 degree); lower extremity, 22.4% of the patients we re improved, 51.5% were unchanged, and 29.4% were worse (most by 1 deg ree). Surgery on tumors of the cervicothoracic and upper thoracic regi on carried a relatively higher morbidity in this series. Radical and q uasiradical resections were not affected by a higher morbidity than th e partial ones. Tumors with large solid components had more pronounced postoperative sensory disturbances; their recovery, although satisfac tory, was delayed, En bloc plastic laminotomies seem helpful in preven ting postoperative spinal deformities.