ORIGINAL PAPER Surgical management of long intramedullary spinal cord tumors Michael E. Tobias & Matthew J. McGirt & Kaisorn L. Chaichana & Ira M. Goldstein & Karl F. Kothbauer & Fred Epstein & George I. Jallo Received: 27 May 2007 / Published online: 18 July 2007 # Springer-Verlag 2007 Abstract Object Spinal cord tumors represent approximately 10– 20% of primary central nervous system tumors. Only 20– 30% of primary intradural tumors are intramedullary. The incidence of longitudinally extensive tumors involving the cervical, thoracic, and lumbar spine is very low (<1% of intramedullary lesions); hence, little literature exists on the management of this entity. Materials and methods We retrospectively reviewed all patients undergoing surgical resection of longitudinally extensive intramedullary spinal cord tumors involving the majority of the spinal cord between 1990 and 2002. Clinical, radiographic, operative, and outcome variables were retrospectively recorded and reported. Results Thirteen patients (eight male, five female) were included in the study. Mean age was 15 years (range, 3–45) at the time of the initial resection. Gross total resection was achieved in eight cases and subtotal resection in five cases. Pathology revealed astrocytoma in six cases (two pilocytic, four grade II), gangliogliomas in four cases, oligodendro- glioma in two cases (one anaplastic), and lipoma in one case. One (8%) patient died from progression of anaplastic oligodendroglioma, and two (15%) underwent reoperation for recurrent tumor (ganglioglioma, grade II astrocytoma). With a mean of 3.4 years (range, 1–12) after surgery, the modified McCormick score (MMS) had worsened in only two (15%) patients, improved in three (23%) patients, and remained stable in seven (54%) patients compared to preoperative MMS. Five (38%) patients required fusion for progressive spinal deformity. Conclusion Gross total resection of holocord and longitu- dinally extensive intramedullary spinal cord tumors can be achieved with preservation of long-term neurological function in many cases. Serial imaging is recommended to guide subsequent resection for tumor recurrence and stabilization of progressive spinal deformity. Keywords Intramedullary spinal cord tumor . Holocord . Pediatric Introduction Tumors of the spinal cord occur with one tenth the incidence of intracranial neoplasms—approximately three to ten per 100,000 population [1]. Although they arise more frequently in the pediatric population and are seldom reported in individuals more than 60 years of age, these Childs Nerv Syst (2008) 24:219–223 DOI 10.1007/s00381-007-0405-7 M. E. Tobias Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, NY, USA M. J. McGirt (*) : K. L. Chaichana : G. I. Jallo Department of Neurosurgery, Johns Hopkins School of Medicine, 3553 Newland Rd, Baltimore 21218, USA e-mail: mmcgirt1@jhmi.edu I. M. Goldstein Department of Neurosurgery, New Jersey Medical School, UMDNJ, Newark, NY, USA K. F. Kothbauer Division of Neurosurgery, Kantonsspital Lucerne, Lucerne, Switzerland F. Epstein Department of Neurosurgery, New York University, New York, NY, USA