TY - JOUR
T1 - Clinical presentation, role of surgery and prognosis in spinal astrocytoma
T2 - Cohort study
AU - Takami, Hirokazu
AU - Brown, Desmond A.
AU - Spear, Joshua A.
AU - Shinya, Yuki
AU - Burns, Terry C.
AU - Clarke, Michelle J
AU - Krauss, William
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2024/1
Y1 - 2024/1
N2 - Spinal astrocytoma is a rare neoplasm with discouraging prognosis, which accounts for 6–8 % of total intramedullary spinal tumors. As this is a rare entity, details of the clinical and molecular features have not been fully unraveled. We evaluated the radiologic findings, perioperative clinical presentation, histopathological features and treatment response in a single institution series of 37 consecutive cases of spinal astrocytomas (WHO grades 1 to 4). We identified 8, 16, 8, and 5 patients with grade 1, 2, 3, and 4 lesions, respectively, from 1988 to 2017. Peak ages were youngest in grade 1, followed in order by grades 4, 3 and 2. Whereas all cases of grade 1 and 4 enhanced with contrast, less than half of the cases of grade 2 tumors enhanced (44 %). Grade 3 tumors had a higher rate of multiplicity at presentation (50 %). A concomitant brain lesion at presentation was present in 14 % and 43 % of grade 2 and 3 lesions, respectively. Progression-free and overall survival were worse in grades 3 and 4 compared to grade 2 lesions but no significant difference was observed between grade 3 and 4. Many patients (16-of-36) experienced new neurological deficits postoperatively regardless of grade. Most patients (88 %) required postoperative rehabilitation, and 61 % were not discharged to home. Discharge destination closely correlated with age (p = 0.002). These clinical findings may be useful in understanding the clinical phenotype and improving the management of this rare disease.
AB - Spinal astrocytoma is a rare neoplasm with discouraging prognosis, which accounts for 6–8 % of total intramedullary spinal tumors. As this is a rare entity, details of the clinical and molecular features have not been fully unraveled. We evaluated the radiologic findings, perioperative clinical presentation, histopathological features and treatment response in a single institution series of 37 consecutive cases of spinal astrocytomas (WHO grades 1 to 4). We identified 8, 16, 8, and 5 patients with grade 1, 2, 3, and 4 lesions, respectively, from 1988 to 2017. Peak ages were youngest in grade 1, followed in order by grades 4, 3 and 2. Whereas all cases of grade 1 and 4 enhanced with contrast, less than half of the cases of grade 2 tumors enhanced (44 %). Grade 3 tumors had a higher rate of multiplicity at presentation (50 %). A concomitant brain lesion at presentation was present in 14 % and 43 % of grade 2 and 3 lesions, respectively. Progression-free and overall survival were worse in grades 3 and 4 compared to grade 2 lesions but no significant difference was observed between grade 3 and 4. Many patients (16-of-36) experienced new neurological deficits postoperatively regardless of grade. Most patients (88 %) required postoperative rehabilitation, and 61 % were not discharged to home. Discharge destination closely correlated with age (p = 0.002). These clinical findings may be useful in understanding the clinical phenotype and improving the management of this rare disease.
KW - Astrocytoma
KW - Glioma
KW - Intramedullary tumor
KW - Prognosis
KW - Spinal tumor
UR - http://www.scopus.com/inward/record.url?scp=85180582017&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85180582017&partnerID=8YFLogxK
U2 - 10.1016/j.wnsx.2023.100269
DO - 10.1016/j.wnsx.2023.100269
M3 - Article
AN - SCOPUS:85180582017
SN - 2590-1397
VL - 21
JO - World Neurosurgery: X
JF - World Neurosurgery: X
M1 - 100269
ER -