Outcome of surgical treatment of highgrade intramedullary astrocytomas

Abstract

Background: Intramedullary astrocytomas
account for about 1% of all CNS tumors and
6–8% of spinal cord tumors. The vast majority
of intramedullary astrocytomas are slowgrowing
lesions.
Objectives: The goal in this study was to
review a series of patients who underwent
surgical removal of intramedullary high-grade
astrocytomas, focusing on the functional
outcome and the effect of multimodality
treatment on the survival of patients with high
grade intramedullary astrocytoma.
Methods: Between June 1999 and June 2004,
22 patients underwent removal of
intramedullary high-grade astrocytomas in four
neurosurgical hospital in Baghdad/ Iraq
(Neurosurgical hospital, Al Shaheed Adnan
Hospital for Surgical Speeialticsa, Nursing
Home Hospital Lesions were located in the
cervical segment of the spinal cord in 12
patients, and patients.
Results: Histological examinations showed
10 Grade III astrocytomas and 12
glioblastomas. Only 2 of the 22 high-grade
astrocytomas could be completely removed. The
clinical postoperative status worsened in
14 patients (63.6%), was unchanged in seven
patients (31.8%), and there was one case of
intraoperative death (4.5%). None of the 22
patients showed improvement in their
neurological status postoperatively. In this series,
excluding the one intra-operative death, all
patients died of the progression of the
malignancy.
Conclusions: Surgical treatment did not
ameliorate the postoperative neurological status;
instead, in the majority of cases, it prompted a
worsening of the deficit. Radiotherapy and
chemotherapy have a little influence on the
length of survival. In this series, multimodality
treatment of intramedullary high-grade
astrocytomas has been shown to increase length
of survival without improving the neurological
status.