ISPUB.COM The Internet Journal of Neurosurgery Volume 6 Number 2 1 of 8 Conservative Surgery and Radiotherapy for Adult Spinal Astrocytoma: Balanced Strategy for Favorable Outcome Y ElSawaf, A ElDeen, A Shakal Citation Y ElSawaf, A ElDeen, A Shakal. Conservative Surgery and Radiotherapy for Adult Spinal Astrocytoma: Balanced Strategy for Favorable Outcome. The Internet Journal of Neurosurgery. 2008 Volume 6 Number 2. Abstract Objective: Spinal cord astrocytomas are considered diffuse infiltrating tumors. The optimal treatment of these lesions has been controversial. The conventional management with partial resection followed by radiotherapy remains. In order to evaluate this traditional and famous strategy, the authors retrospectively review a series of ten consecutive adult patients with spinal cord astrocytoma treated with conservative surgery and radiotherapy. Methods Results: A retrospective analysis of ten adult patients (4 men and 6 women) with spinal cord astorcytoma. The mean age was 33 years. Cervical cord was involved in 2 patients, cervicothoracic in 3, thoracic in 5. Seven patients had low grade astrocytoma and 3 high grade (2 anaplastic, 1 gliobastoma).Surgery was subtotal excision in 1 patient, partial excision in 3 and biopsy in 6 patients. All patients received postoperative radiotherapy to a median dose of 45 Gy in 25 fractions over 5 weeks. The follow-up period ranged from 7 to 48 months. Postradiotherapy, local tumor control was achieved in 7 cases ( 6 low gade, 1 high grade) despite incomplete or no resection. Three patients died, one paraplegic patient of pneumonia, and two patients with high grade astrocytoma from tumor progression or dissemination. Conclusion: There is no significant effect of the extent of resection on local relapse. We believe that conservative surgery and radiotherapy provide a balanced strategy in the treatment of adult spinal astrocytoma to maintain neurological outcome and prevent tumor recurrence. INTRODUCTION Intramedullary spinal cord tumors (IMSCTs) are relatively rare neoplasms, accounting for only 2 to 4% of CNS glial tumors .(6,10) In adults, IMSCTs comprise approximately 20% of all intraspinal neoplasms, whereas in children at least 35% of the tumors are IMSCTs. (11) The optimal treatment of theses lesions has been controversial in both populations. (1,2) In general, astrocytomas have to be considered as infiltrating tumors. Therefore, the identification of cleavage planes carries considerable risk and may even be outright impossible. (4) At surgery, aggressiveness with respect to resection depends on the ability to find and maintain a surgical plane. (9) Because of the concern for surgical morbidity,many autorities treat adult spinal astrocytoma with conservative debulking from inside out and /or biopsy followed by postoperative radiotherapy. (7,8) In order to evaluate this traditional and famous strategy, the authors retrospectively review a series of ten consecutive adult patients with spinal cord astrocytoma treated with conservative surgery and radiotherapy. PATIENTS & METHODS PATIENT POPULATION At the department of neurosurgery of Tanta University Hospital, ten patients with intramedullary spinal cord astrocytomas were treated between January, 2001 and December, 2007. There were 4 men and 6 women, ranging form 21 to 60 years. The mean age was 33 years. Signs and symptoms were usually referable to the site of the solid tumor and consisted of posterior midline pain, paresthesias, and sensory and motor deficits below the level of the tumor. Case records were retrospectively examined for preoperative symptomatology, surgical details, postoperative radiotherapy, and outcomes. The details in our records were verified and an up-to-date functional evaluation was obtained. The functional status was graded according to a modified McCormick scale (Table 1). (26)