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. 2025 Jun 24;17(13):2112.
doi: 10.3390/cancers17132112.

Survival and Functional Outcomes Following Surgical Resection of Intramedullary Spinal Cord Tumors: A Series of 253 Patients over 22 Years

Abdel-Hameed Al-Mistarehi  1 , Khaled J Zaitoun  2 , Sania Javed  3 , Yuanxuan Xia  1 , Andrew Hersh  1 , Abdul Karim Ghaith  1 , Carly Weber-Levine  1 , Kelly Jiang  1 , Majid Khan  1 , Benjamin Mendelson  4 , Noa Ksabi  5 , Daniel M Sciubba  6 , Ziya L Gokaslan  7 , George I Jallo  1   8 , Jean-Paul Wolinsky  9 , Nicholas Theodore  1 , Daniel Lubelski  1
Affiliations

Survival and Functional Outcomes Following Surgical Resection of Intramedullary Spinal Cord Tumors: A Series of 253 Patients over 22 Years

Abdel-Hameed Al-Mistarehi et al. Cancers (Basel). .

Abstract

Purpose: Intramedullary spinal cord tumors (IMSCTs) account for 2-8% of all primary CNS tumors, with ependymal tumors astrocytic tumors and hemangioblastoma being the most prevalent. Due to scarcity of large-scale studies, we aim to provide insights into the long-term neurological and functional outcomes following their resection. Methods: A single-center study where retrospective review of all patients' medical records with IMSCT resection between October 2001 and March 2023 was conducted. Data on demographic characteristics, clinical presentations, and surgical outcomes were collected and analyzed. Results: This study included 253 patients (57.7% male) with a mean age of 36.2 ± 19. The cohort comprised ependymal tumors (45.1%), astrocytic tumors (35.6%), hemangioblastoma (11.1%), and miscellaneous tumors (n = 21; 8.3%). Differences were observed in age at surgery (p < 0.001) and mortality (p = 0.002) across tumor types. Gross total resection was more frequently achieved in hemangioblastoma (96.4%) and ependymal tumors (82.5%) compared to astrocytic tumors (55.6%) (p < 0.001). Long-term postoperative improvements were significant, with reductions in numbness from 74.7% to 52.2%, pain from 42.2% to 25.7%, and bladder incontinence from 23.7% to 11.6%, particularly in ependymal tumors and astrocytic tumors. Kaplan-Meier analysis showed that patients with ependymal tumors had the highest overall survival rates (94.8% at 5 years, 86.7% at 10 years, 76.3% at 15 years, and 65.4% at 20 years) compared to hemangioblastoma (88.7% at 5 and 10 years, and 53.2% at 15 years) and astrocytic tumors (67.8% at 5 years, 58.1% at 10 and 15 years) (p = 0.001). Conclusions: This study highlights the differences in survival and long-term functional outcomes among patients with IMSCTs based on tumor histology and grade.

Keywords: IMSCT; astrocytoma; ependymoma; hemangioblastoma; intramedullary spinal cord tumors; long-term outcomes.

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Conflict of interest statement

Daniel Lubelski: Consults for Carbofix, Icotec, Mindset Medical, and receives fees from Dillon Technologies for the institution (clinical trial). Nicholas Theodore: Receives royalties from and owns stock in Globus Medical. He is a consultant for Globus Medical and has served on the scientific advisory board/other office for Globus Medical.

Figures

Figure 1
Figure 1
Flow chart of study population.
Figure 2
Figure 2
Kaplan–Meier survival analysis of IMSCTs based on (A) histology; (B) low grade (1–2) vs. high grade (3–4).
Figure 3
Figure 3
Kaplan–Meier survival analysis of IMSCTs based on low-grade (1–2) vs. high-grade (3–4) tumors for (A) EPND and (B) ASTR.
See this image and copyright information in PMC

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