INTRADURAL SPINAL TUMOURS: OUTCOME PREDICTORS

Abstract

Study Design: Retrospective case review.

Objective: To assess factors influencing functional outcome, recurrence and survival following surgery for intradural spinal tumours

Subjects: Between January 1994 and December 2001, 115 patients had surgery for intradural spinal tumours: 76 extramedullary (48 male, mean age 54 years): 39 intramedullary (22 male, mean age 44 years).

Outcome measures and analysis: Functional outcome: Frankel scale. Recurrence: new symptoms with tumour growth. Death: post-operative or disease progression. Univariate and multivariate analysis was performed to identify features predicting post-operative functionally useful Frankel scale (4–5), recurrence and survival.

Results: 64 extramedullary tumours were excised, 12 debulked. 21 intramedullary tumours were excised, 13 debulked, 5 biopsied. Commonest tumours: meningioma, schwannoma, ependymoma, astrocytoma. 14 intramedullary tumours received radiotherapy. Mean follow-up was 45 months (range 4–117 months). There were 12 recurrent tumours. There were 8 deaths (2 post-operative, 6 disease-progression). 23% had complications (CSF leak, meningitis, wound infection/dehiscence). Functionally 96% of extramedullary tumours were unchanged/improved, 82% of intramedullary tumours were unchanged/improved. Multivariate analysis demonstrated that recurrence (Odds Ratio 28.2; 95% Confidence Interval 2.3–342.4) was the only significant factor influencing survival for intramedullary tumours. No factors investigated predicted functional outcome or recurrence in intramedullary tumours. No factors predicted any outcome in extramedullary tumours.

Conclusions: Our results were comparable to other studies. The two cases of MRSA meningitis (one death, one paralysis) reflect the growing problem of MRSA in neurosurgical units. Recurrence predicted poor survival in intramedullary tumours.