The Operative Outcome of Primary Intramedullary Gliomas:Analysis of Related Factors

Gwak, Hoshin; Chung, Chun Kee; Kim, Hyun Jib; Cho, Byung Kyo; Choi, Kil Soo; Han, Dae Hee

Abstract

Presented below are the author's report of the result of surgical treatment of 53 intramedullary gliomas. In the analysis of survival data, twenty patients with low grade glioma(except the ependymoma) were followed for a period of mean 54 months, from 1 to 103 months. Five of these patients had died from progression of the disease and the 5 year survival rate was 75%. Nine patients from the above group received postoperative radiation therapy, 6 with no apparent benefit in terms of survival rate. The median survival of thirteen patients with high grade glioma patients were 11 months and there were significant increase of median survival time in patients receiving radiation therapy, from 4 to 17 months(P=0.04). The histological grade is the important factor in determining the survival of glioma patients(P=0.01). In sixteen, out of 20 ependymoma patients, 'radical removal(>95%)' was achieved and the patients showed no signs of recurrence until the mean follow-up period of 42 months. Two of the 4 ependymoma patie nts, whose tumors were partially removed, suffered recurrence and had to be re-operated. We concluded that the 'radical removal' in ependymomas is a significant factor in determining recurrence(P=0.009). The effect of radical removal on survival is not verified statistically. Total removal is more frequently performed in ependymomas than in gliomas(p=0.03). As to functional outcome, better outcome is expected in radical removal on long-term follow-up(p=0.00506), more so in ependymoma than in glioma. Intramedullary gliomas are extremely rare. Therefore sufficient data is unavailable for the determination of efficient treatment plan. However, recently aggressive surgical treatment with the aid of microsurgical techniques has become a trial option.