Skip to main content

Advertisement

SpringerLink
Log in

Prognostic factors in intramedullary astrocytomas: a literature review

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Astrocytomas affect a significant portion of patients with intramedullary tumors. These infiltratively growing tumors are treated by a variety of methods—biopsy and decompressive surgery, maximal safe resection, adjuvant oncological therapy. Also, numerous prognostic factors are reported in the literature. Better understanding of factors that influence prognosis may help in treatment planning with the goal of prolonging survival. We have thus undertaken an extensive literature review in order to define factors affecting prognosis. A total of 38 articles were studied. Only tumor grade was consistently reported as the major factor affecting prognosis. The influence of other clinical factors (age, gender, history length, functional status, tumor location or extent, syrinx or cyst presence) can be speculated upon, but cannot be assessed adequately from the available literature. For both low- and high-grade (HG) astrocytomas, maximal safe tumor resection should be the primary treatment objective but is often not feasible in contrast to other intramedullary and spinal neoplasms. Since the biological nature of spinal cord HG glioma is identical to that of the brain, the same treatment algorithm of maximal safe resection followed by concomitant radio- and chemotherapy would be sensible to implement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

IMSCT:

Intramedullary spinal cord tumor

LG:

Low grade

IMG:

Intermediate grade

HG:

High grade

WHO:

World Health Organization

GTR:

Gross total resection

STR:

Subtotal resection

PR:

Partial resection

Bio:

Biopsy

PFS:

Progression-free survival

OS:

Overall survival

CSS:

Cause-specific survival

LC:

Local control

EOR:

Extent of resection

RT:

Radiotherapy

CHT:

Chemotherapy

MRI:

Magnetic resonance imaging

FU:

Follow-up

MM:

Morbidity and mortality

NR:

Not reported

NS:

Not significant

KPS:

Karnofsky Performance Status

HR:

Hazard ratio

aHR:

Adjusted hazard ratio

References

  1. Abdel-Wahab M, Corn B, Wolfson A, Raub W, Gaspar LE, Curran W Jr, Bustillo P, Rubinton P, Markoe A (1999) Prognostic factors and survival in patients with spinal cord gliomas after radiation therapy. Am J Clin Oncol 22:344–351. doi:10.1097/00000421-199908000-00004

    Article  PubMed  CAS  Google Scholar 

  2. Abdel-Wahab M, Etuk B, Palermo J, Shirato H, Kresl J, Yapicier O, Walker G, Scheithauer BW, Shaw E, Lee C, Curran W, Thomas T, Markoe A (2006) Spinal cord gliomas: a multi-institutional retrospective analysis. Int J Radiat Oncol Biol Phys 64:1060–1071. doi:10.1016/j.ijrobp.2005.09.038

    PubMed  Google Scholar 

  3. Allen JC, Aviner S, Yates AJ, Boyett JM, Cherlow JM, Turski PA, Epstein F, Finlay JL (1998) Treatment of high-grade spinal cord astrocytoma of childhood with “8-in-1” chemotherapy and radiotherapy: a pilot study of CCG-945. Children’s Cancer Group. J Neurosurg 88:215–220

    Article  PubMed  CAS  Google Scholar 

  4. Barker DJ, Weller RO, Garfield JS (1976) Epidemiology of primary tumours of the brain and spinal cord: a regional survey in southern England. J Neurol Neurosurg Psychiatry 39:290–296. doi:10.1136/jnnp.39.3.290

    Article  PubMed  CAS  Google Scholar 

  5. Bouffet E, Pierre-Kahn A, Marchal JC, Jouvet A, Kalifa C, Choux M, Dhellemmes P, Guerin J, Tremoulet M, Mottolese C (1998) Prognostic factors in pediatric spinal cord astrocytoma. Cancer 83:2391–2399. doi:10.1002/(SICI)1097-0142(19981201)83:11<2391::AID-CNCR20>3.0.CO;2-0

    Article  PubMed  CAS  Google Scholar 

  6. Brotchi J, Dewitte O, Levivier M, Baleriaux D, Vandesteene A, Raftopoulos C, Flament-Durand J, Noterman J (1991) A survey of 65 tumors within the spinal cord: surgical results and the importance of preoperative magnetic resonance imaging. Neurosurgery 29:651–656, discussion 656–657. doi:10.1097/00006123-199111000-00002

    Google Scholar 

  7. Cohen AR, Wisoff JH, Allen JC, Epstein F (1989) Malignant astrocytomas of the spinal cord. J Neurosurg 70:50–54

    Article  PubMed  CAS  Google Scholar 

  8. Constantini S, Houten J, Miller DC, Freed D, Ozek MM, Rorke LB, Allen JC, Epstein FJ (1996) Intramedullary spinal cord tumors in children under the age of 3 years. J Neurosurg 85:1036–1043

    Article  PubMed  CAS  Google Scholar 

  9. Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ (2000) Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg 93:183–193

    Article  PubMed  CAS  Google Scholar 

  10. Cooper PR (1989) Outcome after operative treatment of intramedullary spinal cord tumors in adults: intermediate and long-term results in 51 patients. Neurosurgery 25:855–859. doi:10.1097/00006123-198912000-00001

    Article  PubMed  CAS  Google Scholar 

  11. Cristante L, Herrmann HD (1994) Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery 35:69–74. doi:10.1097/00006123-199407000-00011, discussion 74–66

    Article  PubMed  CAS  Google Scholar 

  12. Doireau V, Grill J, Zerah M, Lellouch-Tubiana A, Couanet D, Chastagner P, Marchal JC, Grignon Y, Chouffai Z, Kalifa C (1999) Chemotherapy for unresectable and recurrent intramedullary glial tumours in children. Brain Tumours Subcommittee of the French Society of Paediatric Oncology (SFOP). Br J Cancer 81:835–840. doi:10.1038/sj.bjc.6690772

    Article  PubMed  CAS  Google Scholar 

  13. Epstein F (1986) Spinal cord astrocytomas of childhood. Adv Tech Stand Neurosurg 13:135–169

    PubMed  CAS  Google Scholar 

  14. Epstein F, Epstein N (1982) Surgical treatment of spinal cord astrocytomas of childhood. A series of 19 patients. J Neurosurg 57:685–689

    Article  PubMed  CAS  Google Scholar 

  15. Epstein FJ, Farmer JP, Freed D (1992) Adult intramedullary astrocytomas of the spinal cord. J Neurosurg 77:355–359

    Article  PubMed  CAS  Google Scholar 

  16. Epstein FJ, Farmer JP, Freed D (1993) Adult intramedullary spinal cord ependymomas: the result of surgery in 38 patients. J Neurosurg 79:204–209

    Article  PubMed  CAS  Google Scholar 

  17. Farwell JR, Dohrmann GJ (1977) Intraspinal neoplasms in children. Paraplegia 15:262–273

    PubMed  CAS  Google Scholar 

  18. Garcia DM (1985) Primary spinal cord tumors treated with surgery and postoperative irradiation. Int J Radiat Oncol Biol Phys 11:1933–1939

    PubMed  CAS  Google Scholar 

  19. Goh KY, Velasquez L, Epstein FJ (1997) Pediatric intramedullary spinal cord tumors: is surgery alone enough? Pediatr Neurosurg 27:34–39. doi:10.1159/000121222

    Article  PubMed  CAS  Google Scholar 

  20. Guidetti B, Mercuri S, Vagnozzi R (1981) Long-term results of the surgical treatment of 129 intramedullary spinal gliomas. J Neurosurg 54:323–330

    Article  PubMed  CAS  Google Scholar 

  21. Hanggi D, Steiger HJ (2008) Spontaneous intracerebral haemorrhage in adults: a literature overview. Acta Neurochir (Wien) 150:371–379. doi:10.1007/s00701-007-1484-7, discussion 379

    Article  CAS  Google Scholar 

  22. Hardison HH, Packer RJ, Rorke LB, Schut L, Sutton LN, Bruce DA (1987) Outcome of children with primary intramedullary spinal cord tumors. Childs Nerv Syst 3:89–92. doi:10.1007/BF00271131

    Article  PubMed  CAS  Google Scholar 

  23. Helseth A, Mork SJ (1989) Primary intraspinal neoplasms in Norway, 1955 to 1986. A population-based survey of 467 patients. J Neurosurg 71:842–845

    Article  PubMed  CAS  Google Scholar 

  24. Huddart R, Traish D, Ashley S, Moore A, Brada M (1993) Management of spinal astrocytoma with conservative surgery and radiotherapy. Br J Neurosurg 7:473–481. doi:10.3109/02688699308995069

    Article  PubMed  CAS  Google Scholar 

  25. Hulshof MC, Menten J, Dito JJ, Dreissen JJ, van den Bergh R, Gonzalez D (1993) Treatment results in primary intraspinal gliomas. Radiother Oncol 29:294–300. doi:10.1016/0167-8140(93)90147-Z

    Article  PubMed  CAS  Google Scholar 

  26. Innocenzi G, Raco A, Cantore G, Raimondi AJ (1996) Intramedullary astrocytomas and ependymomas in the pediatric age group: a retrospective study. Childs Nerv Syst 12:776–780. doi:10.1007/BF00261597

    Article  PubMed  CAS  Google Scholar 

  27. Innocenzi G, Salvati M, Cervoni L, Delfini R, Cantore G (1997) Prognostic factors in intramedullary astrocytomas. Clin Neurol Neurosurg 99:1–5. doi:10.1016/S0303-8467(96)00555-0

    Article  PubMed  CAS  Google Scholar 

  28. Jallo GI, Danish S, Velasquez L, Epstein F (2001) Intramedullary low-grade astrocytomas: long-term outcome following radical surgery. J Neurooncol 53:61–66. doi:10.1023/A:1011886516506

    Article  PubMed  CAS  Google Scholar 

  29. Johnson DL, Schwarz S (1987) Intracranial metastases from malignant spinal-cord astrocytoma. Case report. J Neurosurg 66:621–625

    Article  PubMed  CAS  Google Scholar 

  30. Jyothirmayi R, Madhavan J, Nair MK, Rajan B (1997) Conservative surgery and radiotherapy in the treatment of spinal cord astrocytoma. J Neurooncol 33:205–211. doi:10.1023/A:1005758313700

    Article  PubMed  CAS  Google Scholar 

  31. Kalichman L, Hunter DJ (2008) Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J 17:327–335. doi:10.1007/s00586-007-0543-3

    Article  PubMed  Google Scholar 

  32. Karim AB, Afra D, Cornu P, Bleehan N, Schraub S, De Witte O, Darcel F, Stenning S, Pierart M, Van Glabbeke M (2002) Randomized trial on the efficacy of radiotherapy for cerebral low-grade glioma in the adult: European Organization for Research and Treatment of Cancer Study 22845 with the Medical Research Council study BRO4: an interim analysis. Int J Radiat Oncol Biol Phys 52:316–324. doi:10.1016/S0360-3016(01)02692-X

    PubMed  Google Scholar 

  33. Karnofsky D, Abelman W, Craver L (1948) The use of nitrogen mustards in the palliative treatment of carcinoma. Cancer 1:634–656. doi:10.1002/1097-0142(194811)1:4<634::AID-CNCR2820010410>3.0.CO;2-L

    Article  Google Scholar 

  34. Kim MS, Chung CK, Choe G, Kim IH, Kim HJ (2001) Intramedullary spinal cord astrocytoma in adults: postoperative outcome. J Neurooncol 52:85–94. doi:10.1023/A:1010680924975

    Article  PubMed  CAS  Google Scholar 

  35. Kopelson G (1982) Radiation tolerance of the spinal cord previously-damaged by tumor and operation: long term neurological improvement and time-dose-volume relationships after irradiation of intraspinal gliomas. Int J Radiat Oncol Biol Phys 8:925–929

    PubMed  CAS  Google Scholar 

  36. Kopelson G, Linggood R (1982) Infratentorial glioblastoma: the role of neuraxis irradiation. Int J Radiat Oncol Biol Phys 8:999–1003

    PubMed  CAS  Google Scholar 

  37. Kopelson G, Linggood RM (1982) Intramedullary spinal cord astrocytoma versus glioblastoma: the prognostic importance of histologic grade. Cancer 50:732–735. doi:10.1002/1097-0142(19820815)50:4<732::AID-CNCR2820500418>3.0.CO;2-0

    Article  PubMed  CAS  Google Scholar 

  38. Kopelson G, Linggood RM, Kleinman GM, Doucette J, Wang CC (1980) Management of intramedullary spinal cord tumors. Radiology 135:473–479

    PubMed  CAS  Google Scholar 

  39. Kothbauer K, Deletis V, Epstein FJ (1997) Intraoperative spinal cord monitoring for intramedullary surgery: an essential adjunct. Pediatr Neurosurg 26:247–254. doi:10.1159/000121199

    Article  PubMed  CAS  Google Scholar 

  40. Lambert PM (1978) Radiation myelopathy of the thoracic spinal cord in long term survivors treated with radical radiotherapy using conventional fractionation. Cancer 41:1751–1760. doi:10.1002/1097-0142(197805)41:5<1751::AID-CNCR2820410516>3.0.CO;2-N

    Article  PubMed  CAS  Google Scholar 

  41. Lee HK, Chang EL, Fuller GN, Aldape KD, Atkinson GJ, Levy LB, McCutcheon IE, Maor MH (2003) The prognostic value of neurologic function in astrocytic spinal cord glioma. Neuro-oncology 5:208–213. doi:10.1215/S1152851702000595

    Article  PubMed  Google Scholar 

  42. Linstadt DE, Wara WM, Leibel SA, Gutin PH, Wilson CB, Sheline GE (1989) Postoperative radiotherapy of primary spinal cord tumors. Int J Radiat Oncol Biol Phys 16:1397–1403

    PubMed  CAS  Google Scholar 

  43. Lowis SP, Pizer BL, Coakham H, Nelson RJ, Bouffet E (1998) Chemotherapy for spinal cord astrocytoma: can natural history be modified? Childs Nerv Syst 14:317–321. doi:10.1007/s003810050233

    Article  PubMed  CAS  Google Scholar 

  44. Marcus RB Jr, Million RR (1990) The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys 19:3–8

    PubMed  Google Scholar 

  45. McCormick PC, Torres R, Post KD, Stein BM (1990) Intramedullary ependymoma of the spinal cord. J Neurosurg 72:523–532

    Article  PubMed  CAS  Google Scholar 

  46. McGirt MJ, Goldstein IM, Chaichana KL, Tobias ME, Kothbauer KF, Jallo GI (2008) Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients. Neurosurgery 63:55–61. doi:10.1227/01.NEU.0000335070.37943.09

    Article  PubMed  Google Scholar 

  47. McLaughlin MP, Buatti JM, Marcus RB Jr, Maria BL, Mickle PJ, Kedar A (1998) Outcome after radiotherapy of primary spinal cord glial tumors. Radiat Oncol Invest 6:276–280. doi:10.1002/(SICI)1520-6823(1998)6:6<276::AID-ROI5>3.0.CO;2-6

    Article  CAS  Google Scholar 

  48. Merchant TE, Nguyen D, Thompson SJ, Reardon DA, Kun LE, Sanford RA (1999) High-grade pediatric spinal cord tumors. Pediatr Neurosurg 30:1–5. doi:10.1159/000028751

    Article  PubMed  CAS  Google Scholar 

  49. Minehan KJ, Shaw EG, Scheithauer BW, Davis DL, Onofrio BM (1995) Spinal cord astrocytoma: pathological and treatment considerations. J Neurosurg 83:590–595

    Article  PubMed  CAS  Google Scholar 

  50. Nadkarni TD, Rekate HL (1999) Pediatric intramedullary spinal cord tumors. Critical review of the literature. Childs Nerv Syst 15:17–28. doi:10.1007/s003810050321

    Article  PubMed  CAS  Google Scholar 

  51. Nakamura M, Chiba K, Ishii K, Ogawa Y, Takaishi H, Matsumoto M, Toyama Y (2006) Surgical outcomes of spinal cord astrocytomas. Spinal Cord 44:740–745. doi:10.1038/sj.sc.3101932

    Article  PubMed  CAS  Google Scholar 

  52. Nakamura M, Ishii K, Watanabe K, Tsuji T, Takaishi H, Matsumoto M, Toyama Y, Chiba K (2008) Surgical treatment of intramedullary spinal cord tumors: prognosis and complications. Spinal Cord 46:282–286. doi:10.1038/sj.sc.3102130

    Article  PubMed  CAS  Google Scholar 

  53. Nishio S, Morioka T, Fujii K, Inamura T, Fukui M (2000) Spinal cord gliomas: management and outcome with reference to adjuvant therapy. J Clin Neurosci 7:20–23. doi:10.1054/jocn.1999.0128

    Article  PubMed  CAS  Google Scholar 

  54. O’Sullivan C, Jenkin RD, Doherty MA, Hoffman HJ, Greenberg ML (1994) Spinal cord tumors in children: long-term results of combined surgical and radiation treatment. J Neurosurg 81:507–512

    Article  PubMed  Google Scholar 

  55. Phillips TL, Buschke F (1969) Radiation tolerance of the thoracic spinal cord. Am J Roentgenol 105:659–665

    CAS  Google Scholar 

  56. Przybylski GJ, Albright AL, Martinez AJ (1997) Spinal cord astrocytomas: long-term results comparing treatments in children. Childs Nerv Syst 13:375–382. doi:10.1007/s003810050103

    Article  PubMed  CAS  Google Scholar 

  57. Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G (2005) Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery 56:972–981, discussion 972–981

    PubMed  Google Scholar 

  58. Reimer R, Onofrio BM (1985) Astrocytomas of the spinal cord in children and adolescents. J Neurosurg 63:669–675

    Article  PubMed  CAS  Google Scholar 

  59. Robinson CG, Prayson RA, Hahn JF, Kalfas IH, Whitfield MD, Lee SY, Suh JH (2005) Long-term survival and functional status of patients with low-grade astrocytoma of spinal cord. Int J Radiat Oncol Biol Phys 63:91–100. doi:10.1016/j.ijrobp.2005.01.009

    PubMed  Google Scholar 

  60. Rodrigues GB, Waldron JN, Wong CS, Laperriere NJ (2000) A retrospective analysis of 52 cases of spinal cord glioma managed with radiation therapy. Int J Radiat Oncol Biol Phys 48:837–842. doi:10.1016/S0360-3016(00)00690-8

    PubMed  CAS  Google Scholar 

  61. Rossitch E Jr, Zeidman SM, Burger PC, Curnes JT, Harsh C, Anscher M, Oakes WJ (1990) Clinical and pathological analysis of spinal cord astrocytomas in children. Neurosurgery 27:193–196. doi:10.1097/00006123-199008000-00003

    Article  PubMed  Google Scholar 

  62. Samii M, Klekamp J (1994) Surgical results of 100 intramedullary tumors in relation to accompanying syringomyelia. Neurosurgery 35:865–873. doi:10.1097/00006123-199411000-00010, discussion 873

    Article  PubMed  CAS  Google Scholar 

  63. Sanai N, Berger MS (2008) Glioma extent of resection and its impact on patient outcome. Neurosurgery 62:753–766. doi:10.1227/01.neu.0000318159.21731.cf

    Article  PubMed  Google Scholar 

  64. Sandler HM, Papadopoulos SM, Thornton AF Jr, Ross DA (1992) Spinal cord astrocytomas: results of therapy. Neurosurgery 30:490–493. doi:10.1097/00006123-199204000-00003

    Article  PubMed  CAS  Google Scholar 

  65. Santi M, Mena H, Wong K, Koeller K, Olsen C, Rushing EJ (2003) Spinal cord malignant astrocytomas. Clinicopathologic features in 36 cases. Cancer 98:554–561. doi:10.1002/cncr.11514

    Article  PubMed  Google Scholar 

  66. Shirato H, Kamada T, Hida K, Koyanagi I, Iwasaki Y, Miyasaka K, Abe H (1995) The role of radiotherapy in the management of spinal cord glioma. Int J Radiat Oncol Biol Phys 33:323–328. doi:10.1016/0360-3016(95)00179-3

    PubMed  CAS  Google Scholar 

  67. Shrivastava RK, Epstein FJ, Perin NI, Post KD, Jallo GI (2005) Intramedullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis. J Neurosurg Spine 2:249–255

    Article  PubMed  Google Scholar 

  68. Slooff JL, Kernohan JW, MacCarty CS (1964) Primary intramedullary tumors of the spinal cord and filum terminale. WB Saunders Company, Philadelphia

    Google Scholar 

  69. Stein BM, McCormick PC (1992) Intramedullary neoplasms and vascular malformations. Clin Neurosurg 39:361–387

    PubMed  CAS  Google Scholar 

  70. van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K, Malmstrom PO, Collette L, Pierart M, Mirimanoff R, Karim AB (2005) Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet 366:985–990. doi:10.1016/S0140-6736(05)67070-5

    Article  PubMed  Google Scholar 

  71. Wara WM, Phillips TL, Sheline GE, Schwade JG (1975) Radiation tolerance of the spinal cord. Cancer 35:1558–1562. doi:10.1002/1097-0142(197506)35:6<1558::AID-CNCR2820350613>3.0.CO;2-7

    Article  PubMed  CAS  Google Scholar 

  72. Weiner HL, Freed D, Woo H, Rezai AR, Kim R, Epstein FJ (1997) Intra-axial tumors of the cervicomedullary junction: surgical results and long-term outcome. Pediatr Neurosurg 27:12–18. doi:10.1159/000121219

    Article  PubMed  CAS  Google Scholar 

  73. Weiss E, Klingebiel T, Kortmann RD, Hess CF, Bamberg M (1997) Intraspinal high-grade astrocytoma in a child–rationale for chemotherapy and more intensive radiotherapy? Childs Nerv Syst 13:108–112. doi:10.1007/s003810050055

    Article  PubMed  CAS  Google Scholar 

  74. Zakrzewska JM, Lopez BC (2003) Quality of reporting in evaluations of surgical treatment of trigeminal neuralgia: recommendations for future reports. Neurosurgery 53:110–122. doi:10.1227/01.NEU.0000068862.78930.EE

    Article  PubMed  Google Scholar 

  75. Zileli M, Coskun E, Ozdamar N, Ovul I, Tuncbay E, Oner K, Oktar N (1996) Surgery of intramedullary spinal cord tumors. Eur Spine J 5:243–250. doi:10.1007/BF00301327

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to express their gratitude to the library service of Regional Hospital Liberec, particulary to E. Machonská and J. Klímová, for their help in obtaining full text versions of numerous articles cited in this paper.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Regional Hospital Liberec, Husova 10, 46063, Liberec, Czech Republic

    Vladimír Beneš III, Pavel Barsa & Petr Suchomel

  2. Department of Neurosurgery, Central Military Hospital, 1st Medical Faculty, Charles University, Prague, Czech Republic

    Vladimír Beneš Jr.

Authors
  1. Vladimír Beneš III
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pavel Barsa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vladimír Beneš Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Petr Suchomel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vladimír Beneš III.

Additional information

Note added in proof

Concurrently with revision submission (and subsequent acceptance) of this article, the largest series of intramedullary astrocytomas to date appeared on Medline (Minehan KJ, Brown PD, Scheithauer BW, Krauss WE, Wright MP (2009) Prognosis and treatment of spinal cord astrocytoma. Int J Radiat Oncol Biol Phys 73: 727–733). Although the authors are aware of this study, due to this unfortunate timing, this series was not included in the review and readers are kindly asked to turn their attention to it.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beneš, V., Barsa, P., Beneš, V. et al. Prognostic factors in intramedullary astrocytomas: a literature review. Eur Spine J 18, 1397–1422 (2009). https://doi.org/10.1007/s00586-009-1076-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-009-1076-8

Keywords

Search

Navigation