- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Correspondence Address:
Patrick W. Hitchon
Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
DOI:10.4103/2152-7806.135305
Copyright: © 2014 Viljoen S This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.How to cite this article: Viljoen S, Hitchon PW, Ahmed R, Kirby PA. Cordectomy for intramedullary spinal cord glioblastoma with a 12-year survival. Surg Neurol Int 25-Jun-2014;5:101
How to cite this URL: Viljoen S, Hitchon PW, Ahmed R, Kirby PA. Cordectomy for intramedullary spinal cord glioblastoma with a 12-year survival. Surg Neurol Int 25-Jun-2014;5:101. Available from: http://sni.wpengine.com/surgicalint_articles/cordectomy-for-intramedullary-spinal-cord-glioblastoma-with-a-12-year-survival/
Abstract
Background:Prognosis of patients with spinal cord glioblastoma is poor, with an average survival of 18 months. There are reports in the literature describing cordectomy as a treatment option for patients with spinal cord tumors.
Case Description:This is a case report of a patient with spinal cord glioblastoma who, in addition to radiation and chemotherapy, was treated with cordectomy. Outcome of treatment resulted in 12-year survival.
Conclusion:Cordectomy in spinal cord glioblastoma can result in prolonged and meaningful survival.
Keywords: Cordectomy, ependymoma, neuro-oncology, spinal cord glioblastoma
INTRODUCTION
Primary glial tumors including astrocytomas, ependymomas, gangliogliomas, oligodendrogliomas, and subependymomas account for about 80% of intramedullary spinal cord tumors. Of these, spinal cord glioblastoma multiforme (GBM) is rare, representing approximately 7.5% of all spinal cord gliomas.[
Cordectomy has generally been performed to treat syringomyelia, spasticity, and central pain.[
CASE REPORT
In February 2002, a 47-year-old man presented to our institution with a 2-year history of worsening low back pain, difficulty urinating, weakness, and lower extremity paresthesias. His physical examination demonstrated paresis of the lower extremities with hypoesthesia and hypoalgesia and a sensory level of T8. He was hyperreflexic with upgoing toes bilaterally. Magnetic resonance imaging (MRI) with enhancement revealed an enhancing mass of the spinal cord at T8-9, with edema extending to the mid T6 region rostrally and to T12 caudally [
Figure 1
A 47-year-old man with a 2-year history of back pain developed progressive paraparesis 1 week prior to admission. His weakness rapidly progressed to paraplegia. MRI showed an enhancing intramedullary tumor at T8-9 with extensive edema (a). As part of his workup, the patient also underwent MRI of the brain (flair b and enhanced c), which showed no intracranial pathology. Two days later, the patient underwent a T8, T9, and T10 laminectomy and intramedullary tumor resection. Histopathology showed a high degree of nuclear atypia, mitotic activity, and vascular proliferation with thrombosis in regions of necrosis. The pathology was consistent with a glioblastoma (d). Postoperatively, the patient received 30 cycles of radiation therapy. Seven months later, an MRI with enhancement revealed tumor recurrence (e), extending to and including T7-T10. On 11 October 2002, based on the MRI imaging, the patient underwent T6-T11 laminectomy and transdural cordectomy. The illustration shows the excised cord within the dura (f). Histopathology on the resected cord again showed glioblastoma with marked atypia, mitosis, vascular proliferation, and necrosis. In August 2008, he presented with dizziness and diplopia of several months duration. MRI of the brain identified an enhancing mass in the left frontal periventricular white matter (g). Biopsy of this mass showed hypercellular brain parenchyma infiltrated by a population of atypical cells. There was a subependymal accumulation of these cells with mitotic activity (h). A diagnosis of grade III astrocytoma was made. Follow-up thoracic MRI (i) showed a stable exam with postsurgical and postradiation changes from T7 through T11 without gross evidence of progression of disease. Brain MRI in May 2013 (j) showed postradiation effects with ventriculomegaly, but no evidence of tumor recurrence in the frontal lobe. Latest MRI of the brain, taken in November 2013, showed tumor recurrence in the left occipital lobe with extension into the splenium of the corpus callosum, but no evidence of tumor in the frontal lobe (k)
An MRI taken 7 months after surgery revealed tumor recurrence [
For nearly 6 years, he remained stable in regards to his physical examination, and surveillance MRIs of the thoracic cord were performed every 2 months. In August 2008, he presented with dizziness and diplopia of several months duration. MRI of the brain identified a left frontal mass [
DISCUSSION
Cordectomy is a surgical option for patients with spinal cord tumors in the setting of a complete deficit. There are several reports in the literature of spinal cord tumors treated with cordectomy. Kyoshima et al.[
The present cases illustrate cordectomy as an option for patients with high-grade intramedullary spinal cord tumors and a complete neurological deficit. The goal of surgery is resection of the infiltrating tumor and cord while preserving function in the cervical and upper thoracic cord. Preservation of the upper thoracic cord is important for maintaining autonomic function. Autonomic dysreflexia resulting in hemodynamic instability is a known complication of resection of the thoracic cord; therefore, if at all possible, the upper thoracic cord should remain intact.[
Estimates of spinal cord metastases from intracranial GBM have been reported as between 1 and 2%.[
CONCLUSION
In the absence of brain and distant metastases, cordectomy in a patient with spinal cord glioblastoma and paraplegia is a treatment option. Our case and other similar case reports suggest that cordectomy may delay intracranial extension and prolong survival.
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