Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine
<i>Background and Objectives:</i> Intramedullary spinal cord tumors (IMSCT) are rare entities. A location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respira...
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| Language: | English |
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MDPI AG
2023-09-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/59/10/1754 |
| _version_ | 1797573037682327552 |
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| author | Kateryna Goloshchapova Maria Goldberg Bernhard Meyer Maria Wostrack Vicki M. Butenschoen |
| author_facet | Kateryna Goloshchapova Maria Goldberg Bernhard Meyer Maria Wostrack Vicki M. Butenschoen |
| author_sort | Kateryna Goloshchapova |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Intramedullary spinal cord tumors (IMSCT) are rare entities. A location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respiratory dysfunction is scarce. This study aimed to describe these highly eloquent tumors’ early and late postoperative clinical course. <i>Materials and Methods:</i> This is a single-center retrospective cohort study. We included 35 patients with IMSCT at levels of the craniocervical junction to C4 who underwent surgical treatment between 2008 and 2022. The authors analyzed the patients’ preoperative status, tumor- and surgery-specific characteristics, and follow-up functional status. <i>Results:</i> The study cohort included twenty-two patients with grade II ependymoma (62.9%), two low-grade astrocytomas (5.7%), two glioblastomas (5.7%), six hemangioblastomas (17.1%), two metastases (5.7%), and one patient with partially intramedullary schwannoma (2.9%). Gross total resection was achieved in 76% of patients. Early dorsal column-related symptoms (gait ataxia and sensory loss) and motor deterioration occurred in 64% and 44% of patients. At a follow-up of 3.27 ± 3.83 years, 43% and 33% of patients still exhibited postoperative sensory and motor deterioration, respectively. The median McCormick Scale grade was 2 in the preoperative and late postoperative periods, respectively. Only three patients (8.6%) developed respiratory dysfunction, of whom, two patients, both with malignant IMSCT, required prolonged invasive ventilation. <i>Conclusions:</i> More than 60% of the patients with IMSCT in the upper cervical cord developed new neurological deficits in the immediate postoperative period, and more than 40% are permanent. However, these deficits are not disabling in most cases since most patients maintain functional independence as observed by unchanged low McCormick scores. The rate of respiratory insufficiency is relatively low and seems to be influenced by the rapid neurological deterioration in high-grade tumors. |
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| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T21:04:54Z |
| publishDate | 2023-09-01 |
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| series | Medicina |
| spelling | doaj.art-9f88f643a809454bac991ba4476ac6302023-11-19T17:16:43ZengMDPI AGMedicina1010-660X1648-91442023-09-015910175410.3390/medicina59101754Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical SpineKateryna Goloshchapova0Maria Goldberg1Bernhard Meyer2Maria Wostrack3Vicki M. Butenschoen4Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, GermanyDepartment of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, GermanyDepartment of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, GermanyDepartment of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, GermanyDepartment of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany<i>Background and Objectives:</i> Intramedullary spinal cord tumors (IMSCT) are rare entities. A location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respiratory dysfunction is scarce. This study aimed to describe these highly eloquent tumors’ early and late postoperative clinical course. <i>Materials and Methods:</i> This is a single-center retrospective cohort study. We included 35 patients with IMSCT at levels of the craniocervical junction to C4 who underwent surgical treatment between 2008 and 2022. The authors analyzed the patients’ preoperative status, tumor- and surgery-specific characteristics, and follow-up functional status. <i>Results:</i> The study cohort included twenty-two patients with grade II ependymoma (62.9%), two low-grade astrocytomas (5.7%), two glioblastomas (5.7%), six hemangioblastomas (17.1%), two metastases (5.7%), and one patient with partially intramedullary schwannoma (2.9%). Gross total resection was achieved in 76% of patients. Early dorsal column-related symptoms (gait ataxia and sensory loss) and motor deterioration occurred in 64% and 44% of patients. At a follow-up of 3.27 ± 3.83 years, 43% and 33% of patients still exhibited postoperative sensory and motor deterioration, respectively. The median McCormick Scale grade was 2 in the preoperative and late postoperative periods, respectively. Only three patients (8.6%) developed respiratory dysfunction, of whom, two patients, both with malignant IMSCT, required prolonged invasive ventilation. <i>Conclusions:</i> More than 60% of the patients with IMSCT in the upper cervical cord developed new neurological deficits in the immediate postoperative period, and more than 40% are permanent. However, these deficits are not disabling in most cases since most patients maintain functional independence as observed by unchanged low McCormick scores. The rate of respiratory insufficiency is relatively low and seems to be influenced by the rapid neurological deterioration in high-grade tumors.https://www.mdpi.com/1648-9144/59/10/1754intramedullary spinal cord tumours (IMSCT)upper cervical spineneurological deteriorationrespiratory insufficiency |
| spellingShingle | Kateryna Goloshchapova Maria Goldberg Bernhard Meyer Maria Wostrack Vicki M. Butenschoen Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine Medicina intramedullary spinal cord tumours (IMSCT) upper cervical spine neurological deterioration respiratory insufficiency |
| title | Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine |
| title_full | Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine |
| title_fullStr | Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine |
| title_full_unstemmed | Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine |
| title_short | Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine |
| title_sort | neurological outcome and respiratory insufficiency in intramedullary tumors of the upper cervical spine |
| topic | intramedullary spinal cord tumours (IMSCT) upper cervical spine neurological deterioration respiratory insufficiency |
| url | https://www.mdpi.com/1648-9144/59/10/1754 |
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