Goloshchapova, K.; Goldberg, M.; Meyer, B.; Wostrack, M.; Butenschoen, V.M. Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine. Medicina2023, 59, 1754.
Goloshchapova, K.; Goldberg, M.; Meyer, B.; Wostrack, M.; Butenschoen, V.M. Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine. Medicina 2023, 59, 1754.
Goloshchapova, K.; Goldberg, M.; Meyer, B.; Wostrack, M.; Butenschoen, V.M. Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine. Medicina2023, 59, 1754.
Goloshchapova, K.; Goldberg, M.; Meyer, B.; Wostrack, M.; Butenschoen, V.M. Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine. Medicina 2023, 59, 1754.
Abstract
Background and Objectives: Intramedullary spinal cord tumors (IMSCT) are rare entities. Especially, a location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respiratory dysfunction is scarce. The aim of this study was to describe the early and late postoperative clinical course of this highly eloquent tumours.
Patients and Methods: This is a single-centre retrospective cohort study. We included 35 patients with IMSCT at levels of craniocervical junction to C4 who underwent surgical treatment between January 2008 and December 2022. The authors analysed the patients' preoperative status, tumour- and surgery-specific characteristics, and follow-up functional status.
Results: The study cohort included 22 patients with grade II ependymoma (62.9%), 2 low-grade astrocytomas (5.7%), 2 glioblastomas (5.7%), 6 hemangioblastomas (17.1%), 2 metastases (5.7%), and 1 patient with partially intramedullary schwannoma (2.9%). Gross total resection was achieved in 76% of patients. Early dorsal column related symptoms and motor deterioration occurred in 64% and 44% of patients, respectively. At a follow-up of 3.27 ± 3.83 years, 43% and 33% of patients preserved postoperative sensory and motor deterioration, respectively. The median McCormick Scale grade was 2 in the preoperative and late postoperative periods, respectively (p=0.0897, α=0.05). Only two out of 35 patients (5.7%) developed new intermittent respiratory dysfunction, of whom two were transient. There were no surgery-related deaths.
Conclusions: The surgery of IMSCT of the upper cervical spine could be performed without major procedure-related risk. Roughly a half of the patients develop new neurological deficit in the immediate postoperative period. However, most of the patients still maintain functional independence. The rate of respiratory insufficiency is low and is strongly influenced by the rapid neurological deterioration in high-grade tumours.
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
