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Clinical evolution of primary intramedullary tumors in adults

Objectives. The objectives of our clinical study are the evaluation of preoperatory myelic involvement and postoperative follow up, establishing in the mean time the interval and capacity of recovery for adults with primary intramedullary tumors. Material and method. Between January 2001 and December 2008, 14 adult patients diagnosed with intramedullary tumors representing 20,6% of all primary spinal tumors treated in Targu-Mures Neurosurgery Clinic, were studied. The majority of intramedullary tumors were represented by ependymomas (64.3%), followed in equal numbers by astrocytomas and hemangioblastomas (14.3% each) and a rare case of intramedullary epidermoid cyst. Each sign and symptom was monitored with the help of a grading scale going from 5 (asymptomatic patient) to 0 (paraplegia, total absence of functional capacity). Additionally, for monitoring the functional capacity outcome we used the Karnofsky score. The resulted quantitative data of our study was analysed using the T-student test. Results. The major signs of debut were spinal back pain (50%) and motor deficit (35%). The interval between disease debut and diagnostic was variable scaling from one month to 15 years with an average of 28.8 months ± 45.4 months. The clinical status was towards progressive neurological deterioration. At the diagnostic moment all patients presented motor deficit, 12 of them (86%) presented walking disorders, 64% presented sensory deficit and only 12% presented sphincter disturbances. Postoperative evolution was characterized by a transitory neurological deterioration in 57% of cases, the deterioration being recovered during the first 3 months in 75% of cases, in 25% of cases the neurological recovery to preoperatory status extended during a period of 6 months postoperatively. Beyond the interval of 3 months postoperatively, the neurological status was stationary. The main result of surgical intervention was maintenance of preoperative neurological status. Conclusions. The clinical evolution of primary intramedullary tumors in adults was towards progressive neurological deterioration and severe myelic involvement. The surgical intervention maintains rather than improves the preoperative neurological status thus early diagnosis and treatment of this pathology represent the major favorable prognostic factors.