Ogunlade John, Wiginton James G, Elia Christopher, Odell Tiffany, Rao Sanjay C
Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA.
Neurosurgery, Desert Regional Medical Center, Palm Springs, USA.
Cureus. 2019 Jul 26;11(7):e5247. doi: 10.7759/cureus.5247.
Primary spinal astrocytoma is a subtype of glioma, the most common spinal cord tumor found in the intradural intramedullary compartment. Spinal astrocytomas account for 6-8% of all spinal cord tumors and are primarily low grade (World Health Organization grade I (WHO I) or WHO II). They are seen in both the adult and pediatric population with the most common presenting symptoms being back pain, sensory dysfunction, or motor dysfunction. Magnetic Resonance Imaging (MRI) with and without gadolinium is the imaging of choice, which usually reveals a hypointense T1 weighted and hyperintense T2 weighted lesion with a heterogeneous pattern of contrast enhancement. Further imaging which may aid in surgical planning includes computerized tomography, diffusion tensor imaging, and tractography. Median survival in spinal cord astrocytomas ranges widely. The factors most significantly associated with poor prognosis and shorter median survival are older age at initial diagnosis, higher grade lesion based on histology, and extent of resection. The mainstay of treatment for primary spinal cord astrocytomas is surgical resection, with the goal of preservation of neurologic function, guided by intraoperative neuromonitoring. Adjunctive radiation has been shown beneficial and may increase overall survival. The role of adjunctive chemotherapy is employed, however, its benefit has not been clearly defined. Primary spinal cord astrocytomas are rare and challenging to treat. The gold standard treatment is surgical resection. Second-line treatments include radiation and chemotherapy, although, the optimal regimen for adjunctive therapy has not yet been clearly defined.
原发性脊髓星形细胞瘤是胶质瘤的一种亚型，是硬脊膜内髓内最常见的脊髓肿瘤。脊髓星形细胞瘤占所有脊髓肿瘤的6 - 8%，主要为低级别（世界卫生组织I级（WHO I）或WHO II级）。成人和儿童均可发病，最常见的症状为背痛、感觉功能障碍或运动功能障碍。钆增强和未增强的磁共振成像（MRI）是首选的影像学检查，通常显示T1加权像低信号、T2加权像高信号的病变，增强扫描呈不均匀强化。有助于手术规划的进一步影像学检查包括计算机断层扫描、扩散张量成像和纤维束成像。脊髓星形细胞瘤的中位生存期差异很大。与预后不良和中位生存期较短最显著相关的因素是初始诊断时年龄较大、组织学分级较高的病变以及切除范围。原发性脊髓星形细胞瘤的主要治疗方法是手术切除，目标是在术中神经监测的指导下保留神经功能。辅助放疗已被证明有益，可能会提高总生存期。辅助化疗也会使用，但其益处尚未明确界定。原发性脊髓星形细胞瘤较为罕见，治疗具有挑战性。金标准治疗方法是手术切除。二线治疗包括放疗和化疗，不过，辅助治疗的最佳方案尚未明确界定。
