Clinical Study
Poor prognosis despite aggressive treatment in adults with intramedullary spinal cord glioblastoma

https://doi.org/10.1016/j.jocn.2015.05.008Get rights and content

Highlights

  • Spine involvement of glioblastoma is rare.

  • We review five patients with intramedullary spinal cord glioblastoma who underwent surgery.

  • Prognosis is poor with a median survival in our series of 20 months.

  • New treatment strategies are necessary to improve survival in this patient population.

Abstract

We report our institution’s experience with adult patients who underwent surgery for intramedullary spinal cord glioblastoma. Spine involvement of glioblastoma is rare, representing 7.5% of all intramedullary gliomas and 1–3% of all spinal cord tumors. We performed a retrospective review of five male patients with intramedullary spinal cord glioblastoma who underwent surgical resection from 1990 to 2014. Demographic, operative, and postoperative factors were recorded. The median age at treatment was 31 years (range: 18–61) and all men presented with motor or sensory dysfunction. Two had prior surgical resection of an intramedullary World Health Organization Grade III anaplastic astrocytoma lesion with adjuvant chemoradiation. All tumors were present in the cervical (n = 2; 40%) or thoracic (n = 3; 60%) spine, spanning a median of three levels (range: 2–4). Gross total resection was achieved in three men (60%), and there were no intraoperative mortalities or complications. Although one had improvement in his neurological status postoperatively, all five men died with a median time to death of 20 months (range: 2–31). Adult intramedullary spinal cord glioblastoma is rare, and despite aggressive treatment, prognosis is poor, with a median survival in our series of only 20 months. New treatment strategies are necessary to improve survival in this patient population.

Introduction

Spinal cord tumors account for 6–8% of central nervous system tumors and are infrequent compared to intracranial neoplasms [1]. In adults, intramedullary spinal cord tumors account for 5–10% of all spinal tumors, and approximately 90% of spinal cord tumors are of glial origin [2]. The incidence of spinal cord gliomas has been described at 0.22 per 100,000 people [3], with malignant gliomas having an incidence of about 0.12 per 100,000 [4]. The most common types are astrocytomas and ependymomas [5].

Spine involvement of glioblastoma is rare, representing 7.5% of all intramedullary gliomas and 1–3% of all spinal cord tumors [6]. In this series, we describe five adult spinal glioblastoma patients who were treated at our institution from 1990 to 2014.

Section snippets

Materials and methods

After obtaining approval from the Institutional Review Board, a retrospective review of patients with intramedullary spinal cord tumors and pathological diagnoses of glioblastoma from 1990 to 2014 was performed. Five patients were identified, and their medical charts were reviewed including operative notes, radiology reports, and pathology reports.

Demographic factors including age, sex and race were identified. Preoperative information was gathered including the presenting signs and symptoms,

Presentation

Over a 24 year period, five patients underwent surgical resection of an intramedullary glioblastoma of the spine at our institution (Table 1, Table 2). All patients were male and the median age at presentation was 31 years (range: 18–61). The median duration of symptoms was 5 months (range: 1–9). All men presented with motor and sensory dysfunction, three with pain, three with bladder dysfunction, and three with bowel dysfunction. The median McCormick score at presentation was III (range: II–III).

Discussion

We report our institution’s experience with five male patients who underwent surgery for intramedullary spinal glioblastoma and find that despite surgical treatment, the prognosis and clinical outcomes were poor.

Glioblastoma is a malignant tumor of glial cells, most commonly occurring in the brain [7] and with an average annual incidence rate of 3.2 per 100,000 people [8]. It is also the most aggressive type of primary brain tumor, often invading and infiltrating the normal parenchyma and

Conclusion

We present five men who were treated at our institution over a 24 year period for rare adult intramedullary spinal cord glioblastoma. Despite aggressive treatment, the prognosis of this tumor is poor, and we observed a median survival in our series of only 20 months. New treatment strategies must be developed to improve survival in this patient population.

Conflicts of Interest/Disclosures

The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

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