Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Surgical Treatment of Primary Spinal Tumors in the Conus Medullaris

  • Han, In-Ho (Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Kuh, Sung-Uk (Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Chin, Dong-Kyu (Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Kim, Keun-Su (Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Jin, Byung-Ho (Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine) ;
  • Cho, Yong-Eun (Department of Neurosurgery, The Spine and Spinal Cord Institute, Yonsei University College of Medicine)
  • Published : 2008.08.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The objective of this study was to evaluate the characteristics and surgical outcome of the conus medullaris tumors. Methods : We retrospectively reviewed 26 patients who underwent surgery for conus medullaris tumor from August 1986 to July 2007. We analyzed clinical manifestation, preoperative MRI findings, extent of surgical resection, histopathologic type, adjuvant therapy, and outcomes. Results : There were ependymoma (13), hemangioblastoma (3), lipoma (3), astrocytoma (3), primitive neuroectodermal tumor (PNET) (2), mature teratoma (1), and capillary hemangioma (1) on histopathologic type. Leg pain was the most common symptom and was seen in 80.8% of patients. Pain or sensory change in the saddle area was seen in 50% of patients and 2 patients had severe pain in the perineum and genitalia. Gross total or complete tumor resection was obtained in 80.8% of patients. On surgical outcome. modified JOA score worsened in 26.9% of patients, improved in 34.6%, and remained stable in 38.5%. The mean VAS score was improved from 5.4 to 1.8 among 21 patients who had lower back pain and leg pain. Conclusion : The surgical outcome of conus medullaris tumor mainly depends on preoperative neurological condition and pathological type. The surgical treatment of conus medullaris tumor needs understanding the anatomical and functional characteristics of conus meudllaris tumor for better outcome.

Keywords

References

  1. Brotchi J : Intrinsic spinal cord tumor resection. Neurosurgery 50 : 1059-1063, 2002 https://doi.org/10.1097/00006123-200205000-00021
  2. Chen CY, Chen PH, Yao MS, Chu JS, Chan WP : MRI of hemangioblastoma in the conus medullaris. Comput Med Imaging Graph 32 : 78-81, 2008 https://doi.org/10.1016/j.compmedimag.2007.08.008
  3. Choi SH, Kim SJ, Park SH, Cho YJ : Co-existence of lipoma and myxopapillary ependymoma in a filum terminale tumor. J Neurosurg Sci 39 : 378-381, 2006
  4. Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ : Radical excision of intramedullary spinal cord tumors : Surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg 93 : 183-193, 2000 https://doi.org/10.3171/jns.2000.93.2.0183
  5. Fukui M, Chiba K, Kawakami M, Kikuchi S, Konno S, Miyamoto M, et al : An outcome measure for patients with cervical myelopathy : Japanese orthopaedic association cervical myelopathy evaluation questionnaire (joacmeq) : Part 1. J Orthop Sci 12 : 227-240, 2007 https://doi.org/10.1007/s00776-007-1118-1
  6. Jaiswal AK, Jaiswal S, Gupta SK, Singh Gautam VK, Kumar S : Intramedullary tuberculoma of the conus. J Clin Neurosci 13 : 870-872, 2006 https://doi.org/10.1016/j.jocn.2005.11.032
  7. Kahilogullari G, Erdem A, Heper AO, Erden E : Intramedullary mature cystic teratoma of the conus medullaris. A case report. J Neurosurg Sci 50 : 55-58, 2006
  8. Kim YW, Jin BH, Kim TS, Cho YE : Primary intraspinal primitive neuroectodermal tumor at conus medullaris. Yonsei Med J 45 : 533-538, 2004 https://doi.org/10.3349/ymj.2004.45.3.533
  9. Koh ES, Nichol A, Millar BA, Menard C, Pond G, Laperriere NJ : Role of fractionated external beam radiotherapy in hemangioblastoma of the central nervous system. Int J Radiat Oncol Biol Phys 69 : 1521-1526, 2007 https://doi.org/10.1016/j.ijrobp.2007.05.025
  10. Kothbauer KF : Intraoperative neurophysiologic monitoring for intramedullary spinal-cord tumor surgery. Neurophysiol Clin 37 : 407-414, 2007 https://doi.org/10.1016/j.neucli.2007.10.003
  11. Lee TT, Gromelski EB, Green BA : Surgical treatment of spinal ependymoma and post-operative radiotherapy. Acta Neurochir (Wien) 140 : 309-313, 1998 https://doi.org/10.1007/s007010050103
  12. Lin YH, Huang CI, Wong TT, Chen MH, Shiau CY, Wang LW, et al : Treatment of spinal cord ependymomas by surgery with or without postoperative radiotherapy. J Neurooncol 71 : 205-210, 2005 https://doi.org/10.1007/s11060-004-1386-y
  13. McGirt MJ, Chaichana KL, Atiba A, Attenello F, Woodworth GF, Jallo GI : Neurological outcome after resection of intramedullary spinal cord tumors in children. Childs Nerv Syst 24 : 93-97, 2008 https://doi.org/10.1007/s00381-007-0446-y
  14. Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G : Long-term follow-up of intramedullary spinal cord tumors: A series of 202 cases. Neurosurgery 56 : 972-981; discussion 972-981, 2005
  15. Sala F, Bricolo A, Faccioli F, Lanteri P, Gerosa M : Surgery for intramedullary spinal cord tumors: The role of intraoperative (neurophysiological) monitoring. Eur Spine J 16 (Suppl 2) : S130-139, 2007 https://doi.org/10.1007/s00586-007-0423-x
  16. Sandalcioglu IE, Gasser T, Asgari S, Lazorisak A, Engelhorn T, Egelhof T, et al : Functional outcome after surgical treatment of intramedullary spinal cord tumors : experience with 78 patients. Spinal Cord 43 : 34-41, 2005 https://doi.org/10.1038/sj.sc.3101668
  17. Shrivastava RK, Epstein FJ, Perin NI, Post KD, Jallo GI : Intramedullary spinal cord tumors in patients older than 50 years of age : management and outcome analysis. J Neurosurg Spine 2 : 249-255, 2005 https://doi.org/10.3171/spi.2005.2.3.0249
  18. So WS, Lee WJ, Choi HY, Eun JP : Spinal intramedullary lipoma without dysraphism. J Korean Neurosurg Soc 42 : 42-45, 2007
  19. Son YJ, Chung CK, Kim HJ : Surgical results of intramedullary spinal cord ependymomas in adults : retrospective analysis of 51 cases. J Korean Neurosurg Soc 26 : 384-393, 1997
  20. Tobias ME, McGirt MJ, Chaichana KL, Goldstein IM, Kothbauer KF, Epstein F, et al : Surgical management of long intramedullary spinal cord tumors. Childs Nerv Syst 24 : 219-223, 2008 https://doi.org/10.1007/s00381-007-0405-7
  21. Uchiyama T, Sakakibara R, Hattori T, Yamanishi T : Lower urinary tract dysfunctions in patients with spinal cord tumors. Neurourol Urodyn 23 : 68-75, 2004 https://doi.org/10.1002/nau.10070