[Intramedullary tumors. Results of a national investigation in private neurosurgery]. / Les tumeurs intramédullaires. Résultat d'une enquête nationale en neurochirurgie libérale.

ABSTRACT

UNLABELLED The frequency of intramedullary tumors is 0.5 cases per year for 100,000 inhabitants. The study reported herein was a retrospective study conducted from January 1985 to September 2007. MATERIAL: Seventy-nine cases were distributed in the following manner ependymomas, 38; astrocytomas, 22; oligodendrogliomas, four; gangliogliomas, two; hemangioblastomas, 10 (nine sporadic cases and one case of Von Hippel-Lindau disease); primitive melanoma, one; and intramedullary neurinomas, two. Three patients were lost to follow-up and 10 patients died. METHOD: All patients were explored using MRI and were operated using a microsurgical technique. Tumor removal was complete in the cases of ependymoma and hemangioblastoma and subtotal in the cases of astrocytoma. RESULTS: Ependymoma 38 cases with three cases of ependymoblastoma. Mean age 47 years (range, 17-74 years); 17 males and 21 females. Diagnostic delay less than one year, 11; one year, 15 cases; two years, nine cases; three years, three cases. Seven recurrences with one 35 years after a prior removal. Localizations cervical and cervicodorsal, 19; dorsal, ten; dorsolumbar, seven; holomedullary, one. Number of levels concerned 5-12 (with the cysts associated). Mean follow-up was 10 years (range, two months to 35 years). Patients stabilized, 19; worse, six; improved, nine. Patients deceased four, one by suicide, three cases of ependymoblastoma (survival, seven months). Astrocytomas 22 cases, with 14 cases of astrocytoma, two pilocytic astrocytoma, four malignant astrocytoma, and two glioblastoma. Mean age 44 years (range, 22-73 years); 14 males and eight females. Diagnostic delay malignant tumors, one to nine months; low grades; three to six years (range, eight months to 25 years). Number of levels concerned two to eight. Mean follow-up seven years (range, six months to 10 years). Stabilized patients 13; worse, five; deaths, four. Oligodendroglioma four cases. Mean age 58 years; two males and two females. Diagnostic delay 10months. Localization cervical, three; dorsal, one. Oligodendroglioma A, two; B, two. Results: two cases stabilized, one case with recurrence, and one patient deceased. Ganglioglioma two. Both cases were associated with scoliosis. Recurrence in the eighth month and two years for the second case. One patient died. Hemangioblastoma 10 cases, nine sporadic and one case of Von Hippel-Lindau disease. Nine cervical localizations, one on the medulla cone. Mean age 45 years (range, 11-54 years); eight males and two females. Total removal in nine cases. One case of recurrence seven years after a prior surgery and operated a second time with no recurrence after 10 years of follow-up. Intramedullary neurinomas two cases with a total removal and 15 years of follow-up. Primitive melanoma one case with mediothoracic location. Treatment with surgery plus radiotherapy. Follow-up, seven years without recurrence. CONCLUSION: Total removal of the intramedullary tumors is a challenge. In cases of removal, the risk of worsening status is 18-19.5%. Subtotal or incomplete removal 27-40% risk of recurrence.