Spinal astrocytoma

Historical note and nomenclature
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By Jai Grewal MD, Harpreet K Grewal MD, and Santosh Kesari MD PhD

Spinal cord tumors have been recognized for centuries, but significant advances in treatment did not occur until the last century. Pathologic classifications of gliomas began to be attempted in the nineteenth century. In 1835 and in 1846, Virchow described the neuroglia and proposed that some brain could be derived from these cells. He considered some tumors of the spinal cord as derivatives of the perineurium, which contained neuroglia and, therefore, were of neuroglial origin. He was the first to use the word "glioma" in describing a tumor. His classification scheme remained in use until Bailey and Cushing created a new classification scheme in 1926 for CNS tumors, which remains the basis for the current classification we use today (Zulch 1957). Imaging studies were limited to plain films of the spine until myelograms were developed in 1921. The use of magnetic resonance imaging with gadolinium was a significant advance in the diagnosis of intramedullary tumors prior to surgery.

In addition, strides were made in neurosurgical techniques during this time. In 1887, Victor Horsley removed the first intradural tumor successfully, but removal of an intramedullary spinal cord tumor did not occur until 1911 by Elsberg and Beer (Elsberg and Beer 1911). Greenwood reported on 6 patients who underwent complete removal of intramedullary ependymomas (Greenwood 1954), but neurosurgical removal of tumors did not advance significantly until the last decade when the development of the ultrasonic aspirator system improved neurosurgical techniques. Epstein and colleagues advanced the microsurgical techniques used in resecting spinal astrocytomas, achieving apparent cures for some low-grade tumors, especially in children (Epstein and Epstein 1982; Cooper and Epstein 1985; Epstein et al 1992; Constantini et al 2000).