Kyoshima Kazuhiko, Ito Kiyoshi, Tanabe Akihiko, Iwashita Tomomi, Goto Tetsuya, Sato Atsushi, Nakayama Jun
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
J Clin Neurosci. 2002 Mar;9(2):211-6. doi: 10.1054/jocn.2001.0929.
We present a case of malignant astrocytoma of the conus medullaris in a 48-year-old man treated by spinal cordectomy. Preoperative examination revealed a tumor at the T12 to L1 level, and intraparenchymal invasion up to T8. The spinal cord was amputated caudally to the root entry zones of the T9 sensory roots. Additional cordectomies were repeated three times because of tumor infiltration at the cut end. At each procedure, the cord was segmentally transected just caudal to the root entry zones of the p reserving-aid sensory roots to minimize the neural deficit. The final transected level was between T3 and T4, and the cut end did not pathologically reveal any tumor invasion. However, the patient died from tumor recurrence and dissemination. Although the attempt to control the tumor by long segment cordectomy was unsuccessful, spinal cordectomy with wide margin may be a possible treatment for patients with malignant astrocytoma of the conus medullaris presenting with complete deficit below the lesion a nd no dissemination, if in an early stage.
