Clinical Results

The immediate postoperative result is related to the preoperative status, the spinal level of the tumor, and the experience of the surgeon regardless of tumor histology [6, 38, 54, 60, 80, 82, 84, 85, 94, 95, 115, 118, 124, 204, 252, 271, 301, 317, 335, 346, 347]. The extent of tumor removal has only a minor influence on the short-term postoperative outcome [6, 56, 118, 215].

Symptom

Preoperative status

Postoperative status

3 Months postop.

6 Months postop.

1 Year postop.

Pain

Benign Malignant

4.1±1.0 4.1±1.2

3.9 ±0.9 4.2±0.9

4.3±0.9 4.5±0.7

4.3±0.9 4.5±0.7

4.3±0.9**

Hypesthesia

Benign Malignant

3.3±1.0 3.0±0.7

2.4±1.2 2.1±1.3

2.6±1.2 2.3±1.3

2.7±1.2 2.3±1.3

2.7±1.2**

Dysesthesias

Benign Malignant

4.1±0.9 4.2±0.9

4.1±0.9 4.5±0.5

4.0±0.9 4.4±0.7

4.0±1.0 4.4±0.7

3.9±1.0

Gait

Benign Malignant

3.5±1.3 2.5±1.4

2.9±1.4 2.0±1.6

3.2±1.4 2.3±1.8

3.5±1.5 2.2±1.7

3.5±1.4

Motor power

Benign Malignant

3.6±1.3 2.9±1.5

3.2±1.4 2.4±1.7

3.5±1.3 2.6±1.8

3.6±1.3 2.6±1.8

3.7±1.3

Sphincter function

Benign Malignant

4.2±1.3 4.1±1.5

3.7±1.8 3.5±2.1

4.0±1.5 3.5±2.1

4.1±1.4 3.5±2.1

4.1±1.4

Karnofsky score

Benign Malignant

70±16 56±21

62±17 53±19

67±17 56±21

69±17 57±20

69±18

*p<0.05, **p<0.01; statistically significant difference between preoperative status and 1 year or 6 months postoperatively; abbreviation: postop. = postoperatively

*p<0.05, **p<0.01; statistically significant difference between preoperative status and 1 year or 6 months postoperatively; abbreviation: postop. = postoperatively

In our series, the postoperative course was characterized by transient worsening of neurological symptoms in 44% of patients for a few days or even months before functional recovery occurred [38, 60, 120, 215, 217]. In 68% of these, the preoperative status was reached again within 3 months, in 98% within 1 year, and for one patient it took 2 years. We attribute this transient deterioration to edema or interference with spinal cord blood flow, especially on the venous side. The transient deterioration affected gait, motor power, and bladder and bowel function. Therefore, the radiological and clinical examination after 3 months can be considered as a landmark evaluation for a patient who underwent surgery for an intramedullary tumor. Once the operative region has healed, the MRI becomes reliable to assess the radicality of removal, and arachnoid scarring leading to tethering of the cord - if it occurs - can be detected. Most patients have recovered from their postoperative deterioration and one can cautiously make a prognosis as to how the clinical course will probably continue.

As a general rule, the patient can nowadays expect to retain the preoperative neurological status with a successful operation in the long term. This empha

Symptom

Preoperative status

Postoperative status

3 Months postop.

6 Months postop.

1 Year postop.

Subtotal

Biopsy

4.1±1.0 4.1±1.1 4.1±1.0

4.0±0.8 3.7±1.1 4.2±0.9

4.2±0.8 4.3±1.0 4.5±0.8

4.3±0.9 4.5±0.8 4.3±0.8

4.3±0.9

Subtotal

Biopsy

3.3±0.8 3.1±1.3 3.3±1.3

2.3±1.0 2.2±1.4 3.2±1.4

2.5±1.0 2.3±1.4 3.3±1.4

2.6±1.0 2.5±1.4 3.2±1.7

2.6±1.0** 2.6±1.4** 3.2±1.7

Subtotal

Biopsy

3.8±0.9 4.2±1.0 4.3±1.0

3.9±0.9 4.2±1.0 4.4±0.9

3.8±0.9 4.0±1.0 4.5±0.8

3.8±0.9 3.9±1.1 4.6±0.8

4.6±0.7

Subtotal

Biopsy

3.7±1.1 3.0±1.6 4.0±0.9

3.0±1.3 2.2±1.6 3.8±1.1

3.3±1.3 2.8±1.7 3.9±1.0

3.6±1.3 2.8±1.7 4.1±1.0

3.6±1.3 2.9±1.7 4.0±1.1

Subtotal

Biopsy

3.9±1.1 3.1±1.5 3.3±1.1

3.4±1.4 2.7±1.4 3.2±1.4

3.7±1.2 3.0±1.4 3.5±1.5

3.8±1.2 3.1±1.5 3.7±1.3

3.9±1.1 3.1±1.6 3.9±1.2

Sphincter function

Complete

Subtotal

Biopsy

4.3±1.2 4.1±1.6 4.3±1.0

3.8±1.7 3.3±2.1 4.4±1.0

4.1±1.4 3.7±1.9 4.4±1.0

4.2±1.3 3.7±1.8 4.4±1.0

4.2±1.3 3.8±1.8 4.4±1.0

Karnofsky score

Complete

Subtotal

Biopsy

71±15 66±19 74±9

63±17 54±17 71±13

68±16 61±18 72±15

71±17 63±19 74±14

71±17 64±19 73±15

Table 3.6. Clinical course for patients with benign intramedullary tumors related to tumor removal

Statistically significant difference between preoperative status and 1 year or 6 months postoperatively: *p<0.05, **p<0.01

Table 3.6. Clinical course for patients with benign intramedullary tumors related to tumor removal

Statistically significant difference between preoperative status and 1 year or 6 months postoperatively: *p<0.05, **p<0.01

sizes that surgery has to be recommended early. This statement is valid regardless of age or histology. Very good results of surgery can be obtained for small children under the age of 3 years as well as for elderly patients [54, 312]. In the series of Sandalcioglu et al. [289], about two-thirds of the patients were unchanged or improved postoperatively, whereas 34.6% were worse. The preoperative state determined the postoperative result. Thoracic tumors were associated with higher morbidity, according to these authors.

We have analyzed the postoperative clinical course for individual symptoms separately for benign and malignant tumors in detail for the first 12 and

Table 3.8. Clinical course for patients with intramedullary tumors related to the preoperative Karnofsky score

Table 3.7. Multivariate analysis for prediction of a high postoperative Karnofsky score for patients with intramedullary tumors

Factor

ß-value

High preoperative Karnofsky score

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