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Pediatric intramedullary spinal cord tumor outcomes using the WeeFIM scale

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Abstract

Purpose

The Functional Independence Measure for children (WeeFIM) is a user-friendly functional outcomes tool that has been validated across other traditional functional scales. Historically, the significant neurologic and functional deficits of intramedullary spinal cord tumors (IMSCTs) have been monitored by coarse or overbearing functional outcomes tools that make it difficult to measure the slow improvement/decline seen in these patients. This study is the first to report WeeFIM outcomes on a series of IMSCTs with emphasis on an aggressive surgical strategy.

Methods

A retrospective review from 2005 to 2014 was performed for nine patients who underwent resective surgery for intramedullary spinal cord tumors with intraoperative ultrasound and neurophysiologic monitoring. WeeFIM scales were assessed at admission and discharge to evaluate changes in severity of disability and need for assistance.

Results

At the time of this submission, 7/9 patients are alive. The mean WeeFIM improvement was 27 points (8–50 points) with a mean WeeFIM efficiency of 2.0 points/day.

Conclusions

The WeeFIM scale is an appropriate and useful scale for measuring postoperative improvements in patients with IMSCTs undergoing aggressive resective surgery. Attention to intraoperative spinal cord monitoring and prevention of spinal column instability may prevent morbidity related to surgery, and functional outcomes do not appear to be compromised by an aggressive surgical approach.

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References

  1. Allen DD, Mulcahey MJ, Haley SM, DeVivo MJ, Vogel LC, McDonald C, Duffy T, Betz RR (2009) Motor scores on the Functional Independence Measure (FIM) after pediatric spinal cord injury (SCI). Spinal Cord 47:213–217. https://doi.org/10.1038/sc.2008.94

    Article  PubMed  CAS  Google Scholar 

  2. Garcia RA, Gaebler-Spira D, Sisung C, Heinemann AW (2002) Functional improvement after pediatric spinal cord injury. Am J Phys Med Rehabil Assoc Acad Physiatr 81:458–463

    Article  Google Scholar 

  3. Kose N, Muezzinoglu O, Bilgin S, Karahan S, Isikay I, Bilginer B (2014) Early rehabilitation improves neurofunctional outcome after surgery in children with spinal tumors. Neural Regen Res 9:129–134. https://doi.org/10.4103/1673-5374.125340

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ottenbacher KJ, Msall ME, Lyon N, Duffy LC, Granger CV, Braun S (1999) Measuring developmental and functional status in children with disabilities. Dev Med Child Neurol 41:186–194

    Article  PubMed  CAS  Google Scholar 

  5. Ottenbacher KJ, Msall ME, Lyon N, Duffy LC, Ziviani J, Granger CV, Braun S, Feidler RC (2000) The WeeFIM instrument: its utility in detecting change in children with developmental disabilities. Arch Phys Med Rehabil 81:1317–1326. https://doi.org/10.1053/apmr.2000.9387

    Article  PubMed  CAS  Google Scholar 

  6. Ottenbacher KJ, Taylor ET, Msall ME, Braun S, Lane SJ, Granger CV, Lyons N, Duffy LC (1996) The stability and equivalence reliability of the functional independence measure for children (WeeFIM). Dev Med Child Neurol 38:907–916

    Article  PubMed  CAS  Google Scholar 

  7. Epstein FJ, Farmer JP (1990) Pediatric spinal cord tumor surgery. Neurosurg Clin N Am 1:569–590

    Article  PubMed  CAS  Google Scholar 

  8. Koos WT, Day JD (1996) Neurological surgery at the University of Vienna. Neurosurgery 39:583–587

    PubMed  CAS  Google Scholar 

  9. McGirt MJ, Chaichana KL, Atiba A, Attenello F, Yao KC, Jallo GI (2008) Resection of intramedullary spinal cord tumors in children: assessment of long-term motor and sensory deficits. J Neurosurg Pediatr 1:63–67. https://doi.org/10.3171/PED-08/01/063

    Article  PubMed  Google Scholar 

  10. Sahu RK, Das KK, Bhaisora KS, Singh AK, Mehrotra A, Srivastava AK, Sahu RN, Jaiswal AK, Behari S (2015) Pediatric intramedullary spinal cord lesions: pathological spectrum and outcome of surgery. J Pediatr Neurosci 10:214–221. https://doi.org/10.4103/1817-1745.165660

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mulcahey MJ, Gaughan J, Betz RR, Johansen KJ (2007) The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths. Spinal Cord 45:452–459. https://doi.org/10.1038/sj.sc.3101987

    Article  PubMed  CAS  Google Scholar 

  12. Gururangan S, Cavazos CM, Ashley D, Herndon JE, Bruggers CS, Moghrabi A, Scarcella DL, Watral M, Tourt-Uhlig S, Reardon D, Friedman HS (2002) Phase II study of carboplatin in children with progressive low-grade gliomas. J Clin Oncol 20:2951–2958

    Article  PubMed  CAS  Google Scholar 

  13. Packer RJ, Ater J, Allen J, Phillips P, Geyer R, Nicholson HS, Jakacki R, Kurczynski E, Needle M, Finlay J, Reaman G, Boyett JM (1997) Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas. J Neurosurg 86:747–754. https://doi.org/10.3171/jns.1997.86.5.0747

    Article  PubMed  CAS  Google Scholar 

  14. 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

    Article  PubMed  CAS  Google Scholar 

  15. Boström A, Kanther N-C, Grote A, Boström J (2014) Management and outcome in adult intramedullary spinal cord tumours: a 20-year single institution experience. BMC Res Notes 7:908. https://doi.org/10.1186/1756-0500-7-908

    Article  PubMed  PubMed Central  Google Scholar 

  16. Klekamp J (2013) Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results. J Neurosurg Spine 19:12–26. https://doi.org/10.3171/2013.3.SPINE121063

    Article  PubMed  Google Scholar 

  17. Bansal S, Ailawadhi P, Suri A, Kale SS, Sarat Chandra P, Singh M, Kumar R, Sharma BS, Mahapatra AK, Sharma MC, Sarkar C, Bithal P, Dash HH, Gaikwad S, Mishra NK (2013) Ten years’ experience in the management of spinal intramedullary tumors in a single institution. J Clin Neurosci 20:292–298. https://doi.org/10.1016/j.jocn.2012.01.056

    Article  PubMed  Google Scholar 

  18. Ahmed R, Menezes AH, Awe OO, Torner JC (2014) Long-term disease and neurological outcomes in patients with pediatric intramedullary spinal cord tumors. J Neurosurg Pediatr 13:600–612. https://doi.org/10.3171/2014.1.PEDS13316

    Article  PubMed  Google Scholar 

  19. Guss ZD, Moningi S, Jallo GI, Cohen KJ, Wharam MD, Terezakis SA (2013) Management of pediatric spinal cord astrocytomas: outcomes with adjuvant radiation. Int J Radiat Oncol Biol Phys 85:1307–1311. https://doi.org/10.1016/j.ijrobp.2012.11.022

    Article  PubMed  PubMed Central  Google Scholar 

  20. Karikari IO, Nimjee SM, Hodges TR, Cutrell E, Hughes BD, Powers CJ, Mehta AI, Hardin C, Bagley CA, Isaacs RE, Haglund MM, Friedman AH (2015) Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients. Neurosurgery 76(Suppl 1):S4–13; discussion S13. https://doi.org/10.1227/01.neu.0000462073.71915.12

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  CAS  Google Scholar 

  22. Jyothirmayi R, Madhavan J, Nair MK, Rajan B (1997) Conservative surgery and radiotherapy in the treatment of spinal cord astrocytoma. J Neuro-Oncol 33:205–211

    Article  CAS  Google Scholar 

  23. Kutluk T, Varan A, Kafalı C, Hayran M, Söylemezoğlu F, Zorlu F, Aydın B, Yalçın B, Akyüz C, Büyükpamukçu M (2015) Pediatric intramedullary spinal cord tumors: a single center experience. Eur J Paediatr Neurol EJPN Off J Eur Paediatr Neurol Soc 19:41–47. https://doi.org/10.1016/j.ejpn.2014.09.007

    Article  Google Scholar 

  24. Bansal S, Suri A, Borkar SA, Kale SS, Singh M, Mahapatra AK (2012) Management of intramedullary tumors in children: analysis of 82 operated cases. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 28:2063–2069. https://doi.org/10.1007/s00381-012-1835-4

    Article  Google Scholar 

  25. Prada F, Vetrano IG, Filippini A, Del Bene M, Perin A, Casali C, Legnani F, Saini M, DiMeco F (2014) Intraoperative ultrasound in spinal tumor surgery. J Ultrasound 17:195–202. https://doi.org/10.1007/s40477-014-0102-9

    Article  PubMed  PubMed Central  Google Scholar 

  26. Zhou H, Miller D, Schulte DM, Benes L, Bozinov O, Sure U, Bertalanffy H (2011) Intraoperative ultrasound assistance in treatment of intradural spinal tumours. Clin Neurol Neurosurg 113:531–537. https://doi.org/10.1016/j.clineuro.2011.03.006

    Article  PubMed  Google Scholar 

  27. Chandler WF, Knake JE (1983) Intraoperative use of ultrasound in neurosurgery. Clin Neurosurg 31:550–563

    Article  PubMed  CAS  Google Scholar 

  28. Epstein FJ, Farmer JP, Schneider SJ (1991) Intraoperative ultrasonography: an important surgical adjunct for intramedullary tumors. J Neurosurg 74:729–733. https://doi.org/10.3171/jns.1991.74.5.0729

    Article  PubMed  CAS  Google Scholar 

  29. Cheng JS, Ivan ME, Stapleton CJ, Quinones-Hinojosa A, Gupta N, Auguste KI (2014) Intraoperative changes in transcranial motor evoked potentials and somatosensory evoked potentials predicting outcome in children with intramedullary spinal cord tumors. J Neurosurg Pediatr 13:591–599. https://doi.org/10.3171/2014.2.PEDS1392

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ahmed R, Menezes AH, Awe OO, Mahaney KB, Torner JC, Weinstein SL (2014) Long-term incidence and risk factors for development of spinal deformity following resection of pediatric intramedullary spinal cord tumors. J Neurosurg Pediatr 13:613–621. https://doi.org/10.3171/2014.1.PEDS13317

    Article  PubMed  Google Scholar 

  31. McGirt MJ, Chaichana KL, Atiba A, Bydon A, Witham TF, Yao KC, Jallo GI (2008) Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty. J Neurosurg Pediatr 1:57–62. https://doi.org/10.3171/PED-08/01/057

    Article  PubMed  Google Scholar 

  32. Yang C, Li G, Fang J, Wu L, Yang T, Deng X, Xu Y (2014) Intramedullary gangliogliomas: clinical features, surgical outcomes, and neuropathic scoliosis. J Neuro-Oncol 116:135–143. https://doi.org/10.1007/s11060-013-1267-3

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202, USA

    Thomas Noh

  2. Department of Neurosurgery, Division of Pediatric Neurosurgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA

    Manuel S. Vogt & Francesco T. Mangano

  3. Department of Rehabilitation, Division of Pediatric Rehabilitation, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA

    David W. Pruitt

  4. Cancer and Blood Diseases Institute, Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA

    Trent R. Hummel

  5. Department of Neurological Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, MLC 2016, 3333 Burnet Avenue, Cincinnati, OH, 44529, USA

    Francesco T. Mangano

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  1. Thomas Noh
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  2. Manuel S. Vogt
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Correspondence to Francesco T. Mangano.

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Noh, T., Vogt, M.S., Pruitt, D.W. et al. Pediatric intramedullary spinal cord tumor outcomes using the WeeFIM scale. Childs Nerv Syst 34, 1753–1758 (2018). https://doi.org/10.1007/s00381-018-3831-9

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  • DOI: https://doi.org/10.1007/s00381-018-3831-9

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