Initial Management at Presentation
- Surgery favored: With the modern tools of intraoperative monitoring and ultrasonic aspiration, the short-term morbidity has been minimized and the long-term morbidity of radiation is avoided.
- Resection technique varies with tumor: The appreciation of the tumor’s histology is important in determining the technique for its resection. Consequently, a frozen section is advised.
- Complete resection not needed: Constantini et al showed that an 80% resection of these tumors yields the same 5-year event-free survival rate as a gross total resection (10).
- Surgery not tolerated: When spinal cord function does not allow sufficient resection as demonstrated by IOM, then adjunctive therapy is considered. Typically, this is in the setting where continued growth in the tumor after a partial resection threatens further loss of function. It is rare to use multimodality treatments at the time of initial management unless the tumor is anaplastic.
- Radiotherapy: The efficacy of radiotherapy in the treatment of intramedullary spinal cord astrocytomas is well proven while its usefulness in treating other tumors is not established (26).
- Chemotherapy: The efficacy for chemotherapy in managing intramedullary spinal cord tumors has not been proven.
- Benign tumor: A yearly visit including a follow-up MRI study is typically done for these tumors. The frequency will decrease with time but a schedule should probably be established for the life of the patient.
- Malignant tumor: Children with a malignant IMSCT are usually followed by a multidisciplinary neuro-oncology team who will have a protocol in place for following their patients with malignant CNS tumors. Visits and MRI scans will typically be every 3-6 months.
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