Long-Term Neurological and Functional Outcomes in Patients with Intramedullary Spinal Tumors: A Retrospective Analysis of Tumor Types and Morbidity Risks

Introduction: Intramedullary spinal tumors (IMSTs) account for 10% of all primary CNS tumors; the most prevalent types are ependymoma and astrocytoma, followed by hemangioblastoma. We aim to provide insight into long-term neurological and functional outcomes and the risks of permanent morbidity.

Methods: A retrospective review of patient medical records with intramedullary spinal tumors between October 2001 and March 2023 was conducted at the Johns Hopkins Medical Institute. We described their demographic characteristics, clinical presentations, and surgical outcomes.

Results: A total of 253 patients (57.7% male) were included in this study, with a mean age of 36.2 ± 19.1 years and an average follow-up of 45.3 ± 48.2 months. The cohort comprises ependymoma (n=114), astrocytoma (n=90), hemangioblastoma (n=28) and miscellaneous group (n=21). Patients with ependymoma were the oldest among the cohorts of IMSTs on average (42.0 ± 13.6 years), while those with astrocytoma had the youngest age (29.7 ± 23.5 years) but the highest mortality rate (30%). Those with hemangioblastoma had intermediate age (38.5 ± 15.7 years). Kaplan-Meier analysis showed patients with ependymoma had the highest overall survival rates (91.8% at 5 years, 69.4% at 10 and 15 years) compared to hemangioblastoma (85.7% at 5 and 10 years, 0% at 15 years) and astrocytoma (66.7% at 5 years, 62.2% at 10 years, 24.9% at 15 years) (p=0.001). Significant differences were observed in age (p < 0.001) and mortality (p=0.002) across tumor types. Gross total resection was most successful in hemangioblastoma (96.4%) and ependymoma (82.5%) compared to astrocytoma (55.6%) (p < 0.001). Long-term postoperative improvements were significant, with reductions in numbness from 64.7% to 43.8%, pain from 42.2% to 25.7%, and bladder incontinence from 23.7% to 11.6%, particularly in ependymoma and astrocytoma.

Conclusion : This study highlights significant differences in survival and long-term outcomes among patients with IMSTs based on tumor histology.