The significance of clinical and morphological characteristics of spinal cord astrocytomas in the choice of surgical tactics

Abstract

Objective —  to determine the factors affecting the dynamics of the neurological status in the postoperative period in patients with intramedullary spinal cord astrocytomas (SCA) in order to improve the results of their surgical treatment.

Materials and methods. Between 2010 and 2019, we conducted a retrospective study on the surgical treatment outcomes of 39 SCA patients operated on at the SI “Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine”. The age of the patients ranged from 19 to 67 years, with an average age of 41.4 years. Out of the total, 25 patients (64%) were men and 14 patients (36%) were women. We observed cervical localization in 11 (28%) clinical cases, thoracic localization in 25 (64%), and conus medullaris in 3 (8%). All patients underwent a comprehensive clinical and instrumental examination using magnetic resonance imaging with intravenous enhancement, computed tomography, and spondylography. The dynamics of neurological symptoms were evaluated using the modified McCormick before surgery, at the time of the patient’s hospital discharge, and during follow‑up examinations.

Results. Total removal of SCA was performed in 7 (18%) patients, subtotal in 25 (64%), and partial in 7 (18%). Pilocytic astrocytoma (PA) (World Health Organisation (WHO) grade I) was detected in 19 (49%) patients, diffuse astrocytoma (DA) (WHO grade II) in 17 (43%), and anaplastic astrocytoma (AA) (WHO grade III) in 3 (7%). Partial regression of neurological symptoms was noted in 29 (74%) patients, the neurological status remained at the preoperative level in 6 (15%) patients, and a slight increase in the neurological deficit was noted in 4 (10%) patients. Age <60 years is significantly more frequently associated with the growth of PA, while age >60 years is significantly more frequently associated with the growth of AA. The duration of anamnesis (< 1 year and >1 year) and the degree of radicality of the operation were identified as significant factors that can influence the neurological status in the late postoperative period, mainly in patients with PA and DA. However, such factors as tumour location and the degree of infiltration of nearby structures are not statistically significant. AA is associated with an unfavourable prognosis across all important criteria.

Conclusions. The most important determinants of SCA prognosis are preoperative and postoperative neurological condition, resection extent, and histological grade. Patients with minor neurological damage at the time of surgery, those under the age of 60, and those with highly differentiated SCA had the greatest surgical treatment outcomes. Assessment of the preoperative neurological status and determination of the histological type of the tumour are important factors in choosing the optimal surgical tactics, which сan improve treatment outcomes and the quality of life in SCA patients.