PRIMARY SPINAL CORD GLIOBLASTOMA AN INSTITUTIONAL EXPERIENCE AND REVIEW OF LITERATURE
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Keywords
Primary Spinal Cord Tumor, Spinal Glioblastoma, Intramedullary GBM
Abstract
BACKGROUND: Primary spinal cord glioblastoma multiforme (GBM) is a rare clinical entity and prognosis is very poor. Investigation of choice is MRI and the standard treatment is surgery with maximal safe resection followed by adjuvant radiotherapy and chemotherapy. Several studies show that even after such aggressive treatments, the estimated median survival is around 15 months. Our study reports institutional experience and management of four patients with primary spinal GBM who received treatment in our institute from 2018 to2024. All patients succumbed due to illness.
MATERIAL AND METHOD: We analysed the medical records of all patients retrospectively treated at the Department of the Neurosurgery, Mahatma Gandhi Hospital and Medical College Jaipur INDIA, between May 2018 and December 2023 for primary Spinal intramedullary glioblastoma and we found only 4 patients. Pre-operative data and post-operative results demographic characteristics, were then compared with previous literature regarding spinal GBMs and attempt to identify the related factors.
RESULTS: Subtotal resection was achieved in three patients, while a gross total resection was performed in one case; as per protocol all patients underwent surgery followed by radiotherapy and chemotherapy. No significant intraoperative complications or newer postoperative neurological deficit developed; the median overall survival was 11 months. Progression or recurrence of disease was noted in all patients at the 3-months follow-up despite the adjuvant treatments.
CONCLUSIONS: Till now, there is no fixed protocol regarding specific management of spinal glioblastomas: the extent of resection can play an important role but it appears to be insignificant pertaining to long survival. Time interval between the onset of symptoms and treatment and a smaller extension of the lesion seem to be correlated with better outcomes and increase overall survival. However, there is not an adjunctive viable standardized postoperative therapy yet, which results in concrete and persistent improvement of overall survival and progression free survival.
References
2. Johnson D, Schwarz S. Intracranial metastases from malignant spinal-cord astrocytoma. Case report. J Neurosurg. 1987;66:621–625.
3. Medhkour A, Chan M. Extremely rare glioblastoma multiforme of the conus medullaris with holocord and brain stem metastases, leading to cranial nerve deficit and respiratory failure: A case report and review of the literature. Surg Neurol. 2005;63:576–582.
4. Ciappetta P, Salvati M, Capoccia G, Artico M, Raco A, Fortuna A. Spinal glioblastoma: report of seven cases and review of the literature. Neurosurgery. 1991;28:302–306.
5. Asano N, Kitamura K, Seo Y, et al. Spinal cord glioblastoma multiforme with intracranial dissemination - case report. Neurol Med Chir (Tokyo) 1990;30:489–494.
6. Grisold W, Pernetzky G, Jellinger K. Giant-cell glioblastoma of the thoracic cord. Acta Neurochir (Wien) 1981;58:121–126.
7. Guidetti B, Mercuri S, Vagnozzi R. Long-term results of the surgical treatment of 129 intramedullary spinal gliomas. J Neurosurg. 1981;54:323–330.
8. B. Behmanesh, M. Setzer, J. Konczalla, P. Harter, J. Quick-Weller, L. Imoehl, K. Franz, F. Gessler, V. Seifert, G. Marquardt. Management of Patients with Primary Intramedullary Spinal Cord Glioblastoma. World Neurosurg., 98 (2017), pp. 198-202
9. S.K. Konar, S.C. Bir, T.K. Maiti, A. Nanda. A systematic review of overall survival in pediatric primary glioblastoma multiforme of the spinal cord. J. Neurosurg. Pediatr., 19 (2) (2017), pp. 239-248
10. F.J. Epstein, J.P. Farmer, D. Freed. Adult intramedullary astrocytomas of the spinal cord. J. Neurosurg., 77 (3) (1992), pp. 355-359
11. W.C. Choi, J.H. Lee, S.H. Lee. Spinal cord glioblastoma multiforme of conus medullaris masquerading as high lumbar disk herniation. Surg. Neurol., 71 (2) (2009), pp. 234-237
12. N. Morais, L. Mascarenhas, J.P. Soares-Fernandes, A. Silva, Z. Magalhães, J.A. Costa. Primary spinal glioblastoma: a case report and review of the literature. Oncol. Lett., 5 (3) (2013), pp. 992-996
13. H. Adams, J. Avendaño, S.M. Raza, Z.L. Gokaslan, G.I. Jallo, A. Quiñones-Hinojosa, Prognostic factors and survival in primary malignant astrocytomas of the spinal cord: a population-based analysis from 1973 to 2007, Spine (Phila Pa 1976) 37 (12) (2012) E727-35.
14. M. Santi, H. Mena, K. Wong, K. Koeller, C. Olsen, E.J. Rushing. Spinal cord malignant astrocytomas. Clinicopathologic features in 36 cases. Cancer, 98 (3) (2003), pp. 554-561
15. R. Stupp, W.P. Mason, M.J. vandenBent, M. Weller, B. Fisher, M.J.B. Taphoorn, K. Belanger, A.A. Brandes, C. Marosi, U. Bogdahn, J. Curschmann, R.C. Janzer, S.K. Ludwin, T. Gorlia, A. Allgeier, D. Lacombe, J.G. Cairncross, E. Eisenhauer, R.O. Mirimanoff Group, Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N. Engl. J. Med., 352 (10) (2005), pp. 987-996
16. Shen CX, Wu JF, Zhao W, Cai ZW, Cai RZ, Chen CM. Primary spinal glioblastoma multiforme: A case report and review of the literature. Med (United States) 2017;96:1–6.
17. Yanamadala V, Koffie RM, Shankar GM, Kumar JI, Buchlak QD, Puthenpura V, et al. Spinal cord glioblastoma: 25 years of experience from a single institution. J Clin Neurosci. 2016;27:138–41.
18. Timmons JJ, Zhang K, Fong J, Lok E, Swanson KD, Gautam S, et al. Literature review of spinal cord glioblastoma. Am J Clin Oncol Cancer Clin Trials. 2018;41:1281–7.
19. Raco A, Piccirilli M, Landi A, Lenzi J, Delfini R, Cantore G. High-grade intramedullary astrocytomas: 30 years’ experience at the neurosurgery department of the university of Rome “sapienza”: Clinical article. J Neurosurg Spine. 2010;12:144–53.
20. McGirt MJ, Goldstein IM, Chaichana KL, Tobias ME, Kothbauer KF, Jallo GI. Extent of surgical resection of malignant astrocytomas of the spinal cord: Outcome analysis of 35 patients. Neurosurgery. 2008;63:55–60.
21. Jokovic M, Somma T, Ilic R, Guizzardi G, Stanimirovic A, Raicevic S, Milicevic M, Grujicic D, Solari D. Primary spinal glioblastoma multiforme. Single center experience and literature review. Interdisciplinary Neurosurgery. 2021 Jun 1;24:101109.
22. S. Lam, Y. Lin, S. Melkonian. Analysis of risk factors and survival in pediatric high-grade spinal cord astrocytoma: a population-based study. Pediatr. Neurosurg., 48 (5) (2012), pp. 299-305
23. H.M. Sandler, S.M. Papadopoulos, A.F. Thornton, D.A. Ross. Spinal cord astrocytomas: results of therapy. Neurosurgery, 30 (4) (1992), pp. 490-493
24. E. Caro-Osorio, J.C. Herrera-Castro, A. Barbosa-Quintana, M. Benvenutti-Regato. Primary Spinal Cord Small-Cell Glioblastoma: Case Report and Literature Review. World Neurosurg., 118 (2018), pp. 69-70
25. X. Cheng, S. Lou, S. Huang, H. Chen, J. Liu. Primary Spinal Cord Glioblastoma Multiforme: A Retrospective Study of Patients at a Single Institution. World Neurosurg., 106 (2017), pp. 113-119
26. A. Liu, E.W. Sankey, C. Bettegowda, P.C. Burger, G.I. Jallo, M.L. Groves Poor prognosis despite aggressive treatment in adults with intramedullary spinal cord glioblastoma. J. Clin. Neurosci., 22 (10) (2015), pp. 1628-1631
27. T. Seki, K. Hida, S. Yano, T. Aoyama, I. Koyanagi, K. Houkin. Surgical Outcomes of High-Grade Spinal Cord Gliomas. Asian Spine J., 9 (6) (2015), pp. 935-941
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Dr Yogesh Agrawal
MBBS, MS MCh, Associate Professor, Department of Neurosurgery, Mahatma Gandhi Medical College & Hospital, Jaipur (INDIA),
Dr Ruchi Agrawal
MBBS, MD, Associate Professor, Department of Physiology, Govt. Medical College, Dausa (INDIA), Mob.: 8955260072
Dr Ankur Yogi
MBBS, MD, Assistant Professor, Department of Physiology, Govt. Medical College, Dausa (INDIA)
Dr Anmol Singh Randhawa
Senior Resident, Department of Neurosurgery, Mahatma Gandhi Medical College & Hospital, Jaipur (INDIA),
Dr Rohin Bhatia
MBBS, MS, MCh, Professor, Department of Neurosurgery, Mahatma Gandhi Medical College & Hospital, Jaipur (INDIA).
Dr Pankaj Gupta
MBBS, MS, MCh, Professor & Head, Department of Neurosurgery, Mahatma Gandhi Medical College & Hospital, Jaipur (INDIA),
Dr B S Sharma
MBBS, MS, MCh, Emeritus Professor, Department of Neurosurgery, Mahatma Gandhi Medical College & Hospital, Jaipur (INDIA),