Surgical treatment of intramedullary tumors (spinal cord and medulla oblongata). Analysis of 16 cases

Abstract

From February 1987 to July 1988, 16 patients of our clinic with intramedullary tumors (seven astrocytomas, six ependymomas, two angiomas with intramedullary hematomyelia, and one angioblastoma of the medulla oblongata) underwent surgery. Radical excision was possible in six cases with tumors in the cervical and/or thoracic region as well as in two cases with tumors in the medulla oblongata. In the group of patients with cervical and/or thoracic tumors, seven showed improvement, up to complete remission of the neurological symptoms. From eight patients with tumors of the medulla oblongata, one patient showed an invasive tumor of the medulla oblongata and pons with corresponding extensive neurological deficits, and died six weeks after surgery. The neurologic symptoms of the other seven patients improved after a postoperative interval of at least six weeks. The surgical approach to tumors of the medulla oblongata or spinal cord was performed by midline incision. Occasionally, a dorsal root entry zone (DREZ) incision was used when the tumor showed strictly unilateral localization. Tumors of the rhomboid fossa were approached by a lateral incision to avoid damage to nuclear structures. The more rostral the tumor localization (medulla oblongata, pons), the less complete was the surgery: only one ependymoma of the medulla oblongata was accessible to total extirpation. The tumor dignity worsened with ascending level of tumor localization. As described generally in the literature, neurological deficits of those patients with tumors in the medulla oblongata increased in the first few postoperative weeks before they began to improve. Chemotherapy, radiation therapy or decompressive laminectomy by themselves only lead to an improvement and are, therefore, not recommended.