Characteristic and surgical results of multisegment intramedullary cervical spinal cord tumors

Background: To evaluate the clinical characteristic, microsurgical treatment and outcomes of patients with multi-segment intramedullary cervical spinal cord tumors (MSICCT). Materials and methods: Prospective single center cohort study. 63 patients underwent microsurgery for MSICCT. Pre and postoperative function were assessed using the modified McCormick's grade, IJOA scoring system, and analyzed using the appropriate statistical tests. Results: 41 males, 22 females, three spinal segments were involved in 22(35%) cases, four or more in 41(65%) of cases. Majority of the tumors were ependymoma (54%), followed by astrocytoma (low grade 25%, high grade 8%). McCormick's grade: I&II in 40 patients (64%). There was no statistical difference between preoperative and three-month postoperative IJOA scores (P = 0.76), indicating no significant neurological deterioration after surgery. The extent of surgical resection was highly correlated to histological tumor type of MSICCT (χ2 = 34.82, P = 0.0001) and three-month postoperative IJOA scores (F = 2.62, P = 0.006). There is a high proportion of total resection in ependymomas, haemangioblastomas, cavernomas and schwannoma, whereas, we only achieved partial resection in most gliomas. With a mean follow up of 5.5 years (3 months–more than 12 years), clinical outcome improved or stabilized in 91% of cases (80% improved, 11% stabilized, 9% deteriorated). Conclusion: This series of MSICCT showed that high extent of surgical resection could be achieved in most ependymomas with good long-term outcome. Astrocytomas, in contrary remained challenging with 25% achieved gross total resection. Overall, compared to previous surgical series, we showed encouraging improvement in the clinical outcome of these patients managed surgically