Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary XXXX : analysis of 101 consecutive cases.

@entity1 @entity279 @entity424 @entity1494 @entity5 @entity16 @entity816 @entity4097
OBJECT: With the introduction of electrophysiological spinal cord monitoring, surgeons have been able to perform radical resection of intramedullary @entity4097 (IMSCTs). However, factors associated with @entity5 resectability, @entity5 recurrence, and long-term neurological outcome are poorly understood. METHODS: The authors retrospectively reviewed 101 consecutive cases of IMSCT resection in adults and @entity1 at a single institution. Neurological function and MR images were evaluated preoperatively, at discharge, 1 month after surgery, and every 6 months thereafter. Factors associated with gross-total resection (GTR), progression-free survival (PFS), and long-term neurological improvement were assessed using multivariate regression analysis. RESULTS: The mean age of the @entity1 was 41 +/- 18 years and 17 (17%) of the @entity1 were pediatric. Pathological type included @entity424 in 51 cases, @entity279 in 15, @entity816 in 16, WHO Grade II @entity816 in 10, and @entity5 in 9. A GTR was achieved in 60 cases (59%). Independent of histological @entity5 type, an intraoperatively identifiable @entity5 plane (OR 25.3, p < 0.0001) and decreasing @entity5 size (OR 1.2, p = 0.05) were associated with GTR. Thirty-four @entity1 (34%) experienced acute @entity16 after surgery (associated with increasing age [OR 1.04, p = 0.02] and with intraoperative change in motor evoked potentials [OR 7.4, p = 0.003]); in 14 (41%) of these @entity1 the change returned to preoperative baseline within 1 month. In 31 @entity1 (31%) @entity5 progression developed by last follow-up (mean 19 months). @entity5 histology (p < 0.0001) and the presence of an intraoperatively identified @entity5 plane (hazard ratio [HR] 0.44, p = 0.027) correlated with improved PFS. A GTR resulted in improved PFS for @entity279 (HR 0.004, p = 0.04) and @entity424 (HR 0.2, p = 0.02), but not @entity816 . Fifty-five @entity1 (55%) maintained overall neurological improvement by last follow-up. The presence of an identifiable @entity5 plane (HR 3.1, p = 0.0004) and improvement in neurological symptoms before discharge (HR 2.3, p = 0.004) were associated with overall neurological improvement by last follow-up (mean 19 months). CONCLUSIONS: Gross-total resection can be safely achieved in the vast majority of IMSCTs when an intraoperative plane is identified, independent of pathological type. The incidence of acute perioperative @entity16 increases with @entity1 age but will improve to baseline in nearly half of @entity1 within 1 month. Long-term improvement in motor, sensory, and @entity1494 may be achieved in a slight majority of @entity1 and occurs more frequently in @entity1 in whom a surgical plane can be identified. A GTR should be attempted for @entity424 and @entity279 , but it may not affect PFS for @entity816 . For all @entity5 , the intraoperative finding of a @entity5 plane of resection carries positive prognostic significance across all pathological types.
