Spinal cord gliomas are the most common type of primary intramedullary malignant tumors, with a low incidence and a peak onset age of approximately 35 years. They are slightly more prevalent in males than females. Clinical manifestations vary depending on tumor characteristics and location, typically presenting with axial pain and displaying a tendency for unilateral, infiltrative growth. Prognosis is generally poor, and effective treatment options are limited aside from surgical resection. Common surgical approaches for intramedullary tumor removal include the posterior median sulcus approach, the dorsolateral sulcus approach, and surface entry techniques.
Preliminary clinical observations suggest that the dorsolateral sulcus approach may offer superior preservation of neurological function and quality of life. However, due to limited research evaluating the safety and efficacy of different surgical routes, the traditional posterior median sulcus approach remains widely used.
This single-center, registry-based cohort study aims to compare the outcomes of spinal cord glioma resection via the dorsolateral sulcus approach versus the posterior median sulcus approach. Patients with laterally located tumors undergoing surgical treatment, classified according to the 2021 WHO criteria, will be included. Neurological function scores and quality-of-life assessments will be used to evaluate prognosis and survival, in order to determine the optimal surgical approach for spinal cord glioma resection.
Age between 3 and 75 years
Undergoing surgical resection of spinal cord tumor
Histopathological diagnosis of spinal cord glioma based on routine pathological examination
Availability of complete clinical data and willingness to participate in follow-up
Age under 3 years or over 75 years
Receipt of radiotherapy, chemotherapy, or anti-tumor biological therapy within 1 month prior to enrollment
Receipt of immunotherapy within 3 months prior to enrollment
Participation in other clinical trials within 3 months prior to enrollment
This is a single-center registry study including patients aged 3-75 years who were diagnosed with spinal cord glioma by histopathology and underwent surgical resection. All participants provided informed consent and were able to complete follow-up assessments.
Cohort
Other
Not listed
Extent of resection
The extent of tumor resection was evaluated by comparing the preoperative and postoperative magnetic resonance images, and the criterion for judgment was that the tumor volume decreased by more than 50%.
Number of Participants with Preserved Dorsal Column Function (Assessed by clinical neurological examination and intraoperative electrophysiological monitoring )
Dorsal column function will be assessed through standardized clinical neurological examination, including evaluation of proprioception (joint position sense), vibration sense, and gait. Dysfunction is defined as the presence of generalized numbness or painful dysesthesias below the surgical level, accompanied by proprioceptive loss and/or gait disturbance. \* This definition is based on previously published clinical criteria for dorsal column dysfunction in patients with intramedullary spinal cord tumors, as described by Manzano et al.
Pain Level (VAS Score)
Assessment of pain severity using the Visual Analog Scale (VAS), with scores ranging from 0 (no pain) to 100 (worst possible pain).
Neurological Functional Status (McCormick Grade)
Evaluation of neurological status using the McCormick Functional Grading Scale to compare surgical approaches. The scale ranges from Grade I (normal gait and function) to Grade IV (severe disability or paraplegia).
SF-36 quality of life metrics
Quality of life will be assessed using the 36-Item Short Form Survey (SF-36), a validated questionnaire that evaluates multiple health domains including physical functioning, bodily pain, general health, vitality, social functioning, emotional role, and mental health. Each domain is scored from 0 to 100, with higher scores indicating better health-related quality of life.
Progression-Free Survival (PFS)
Progression-free survival is defined as the time from surgery to the first documented tumor progression or death from any cause. Progression is determined by imaging and/or neurological deterioration.
Overall Survival (OS)
Overall survival is defined as the time from surgery to death from any cause. Survival status will be monitored through clinic visits or follow-up contact.
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