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Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics

Intramedullary astrocytomas represent approximately 30%–40% of all intramedullary tumors and are the most common intramedullary tumor in children. Surgical resection is considered the mainstay of treatment in symptomatic patients with neurological deficits. Gross total resection (GTR) can be difficu...

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Autores principales: Hersh, Andrew M., Jallo, George I., Shimony, Nir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9485889/
https://www.ncbi.nlm.nih.gov/pubmed/36147920
http://dx.doi.org/10.3389/fonc.2022.982089
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author Hersh, Andrew M.
Jallo, George I.
Shimony, Nir
author_facet Hersh, Andrew M.
Jallo, George I.
Shimony, Nir
author_sort Hersh, Andrew M.
collection PubMed
description Intramedullary astrocytomas represent approximately 30%–40% of all intramedullary tumors and are the most common intramedullary tumor in children. Surgical resection is considered the mainstay of treatment in symptomatic patients with neurological deficits. Gross total resection (GTR) can be difficult to achieve as astrocytomas frequently present as diffuse lesions that infiltrate the cord. Therefore, GTR carries a substantial risk of new post-operative deficits. Consequently, subtotal resection and biopsy are often the only surgical options attempted. A midline or paramedian sulcal myelotomy is frequently used for surgical resection, although a dorsal root entry zone myelotomy can be used for lateral tumors. Intra-operative neuromonitoring using D-wave integrity, somatosensory, and motor evoked potentials is critical to facilitating a safe resection. Adjuvant radiation and chemotherapy, such as temozolomide, are often administered for high-grade recurrent or progressive lesions; however, consensus is lacking on their efficacy. Biopsied tumors can be analyzed for molecular markers that inform clinicians about the tumor’s prognosis and response to conventional as well as targeted therapeutic treatments. Stratification of intramedullary tumors is increasingly based on molecular features and mutational status. The landscape of genetic and epigenetic mutations in intramedullary astrocytomas is not equivalent to their intracranial counterparts, with important difference in frequency and type of mutations. Therefore, dedicated attention is needed to cohorts of patients with intramedullary tumors. Targeted therapeutic agents can be designed and administered to patients based on their mutational status, which may be used in coordination with traditional surgical resection to improve overall survival and functional status.
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spelling pubmed-94858892022-09-21 Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics Hersh, Andrew M. Jallo, George I. Shimony, Nir Front Oncol Oncology Intramedullary astrocytomas represent approximately 30%–40% of all intramedullary tumors and are the most common intramedullary tumor in children. Surgical resection is considered the mainstay of treatment in symptomatic patients with neurological deficits. Gross total resection (GTR) can be difficult to achieve as astrocytomas frequently present as diffuse lesions that infiltrate the cord. Therefore, GTR carries a substantial risk of new post-operative deficits. Consequently, subtotal resection and biopsy are often the only surgical options attempted. A midline or paramedian sulcal myelotomy is frequently used for surgical resection, although a dorsal root entry zone myelotomy can be used for lateral tumors. Intra-operative neuromonitoring using D-wave integrity, somatosensory, and motor evoked potentials is critical to facilitating a safe resection. Adjuvant radiation and chemotherapy, such as temozolomide, are often administered for high-grade recurrent or progressive lesions; however, consensus is lacking on their efficacy. Biopsied tumors can be analyzed for molecular markers that inform clinicians about the tumor’s prognosis and response to conventional as well as targeted therapeutic treatments. Stratification of intramedullary tumors is increasingly based on molecular features and mutational status. The landscape of genetic and epigenetic mutations in intramedullary astrocytomas is not equivalent to their intracranial counterparts, with important difference in frequency and type of mutations. Therefore, dedicated attention is needed to cohorts of patients with intramedullary tumors. Targeted therapeutic agents can be designed and administered to patients based on their mutational status, which may be used in coordination with traditional surgical resection to improve overall survival and functional status. Frontiers Media S.A. 2022-09-06 /pmc/articles/PMC9485889/ /pubmed/36147920 http://dx.doi.org/10.3389/fonc.2022.982089 Text en Copyright © 2022 Hersh, Jallo and Shimony https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Hersh, Andrew M.
Jallo, George I.
Shimony, Nir
Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics
title Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics
title_full Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics
title_fullStr Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics
title_full_unstemmed Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics
title_short Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics
title_sort surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9485889/
https://www.ncbi.nlm.nih.gov/pubmed/36147920
http://dx.doi.org/10.3389/fonc.2022.982089
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