Clinico-radiological profile and nuances in the management of cervicomedullary junction intramedullary tumors

BACKGROUND: Cervicomedullary junction (CMJ) intramedullary tumors comprise of tumors that often pose a surgical challenge even in the present era. Though classified under brainstem glioma CMJ tumors are well amenable for surgical resection and have a good outcome. Various factors are involved in the outcome of these patients following surgery and a proper pre-operative assessment is often required to reduce the morbidity and mortality. MATERIALS AND METHODS: Patients admitted in the Department of Neurosurgery with a diagnosis of CMJ intramedullary tumors from January 2001 to January 2010 were included in the study. Patients were analyzed retrospectively regarding their symptomatology, clinical findings, radiology and outcome after surgery. All patients underwent pre-operative magnetic resonance imaging (MRI) and post-operatively all were managed in the neurosurgery intensive care unit for days to weeks or as dictated by the clinical condition of the patient. RESULTS: A total of 32 patients were included in the present study. The number of males was 21 (65.6%) and females were 11 (34.4%) respectively. The mean age of presentation was 22.97 ± 9.8 years and the mean duration of pre-operative symptoms was 13.3 ± 12.9 months. The tumor had extension from the CMJ into the cervical region in 17 (53.1%) and into the medullary region in 14 (43.8%) patients. Tumor decompression was done in 9 (28.1%) patients and gross near total excision done in 23 (71.87%) patients. CONCLUSIONS: Cervicomedullary tumors are a subset of tumors quite distinct from the usual brainstem tumors. Patients having predominant cervical involvement present early and have less post-operative deficits. Those with predominantly more medullary involvement present late, hence have a much more morbid outcome. Though closely related to vital neural structures, surgery forms the mainstay of treatment. Adequate pre-operative planning and preparation of the patient along with intense post-operative monitoring and ventilatory assistance as and when required helps in a good surgical outcome.