Thoracic intramedullary spinal cord astrocytoma associated with syringomyelia: a case report of gross total resection.

INTRODUCTION AND

IMPORTANCE

Intramedullary spinal cord tumors (IMSCTs) are rare, accounting for 2-4% of central nervous system neoplasms. Astrocytomas comprise about 30% of these tumors and are typically infiltrative. The coexistence of astrocytoma with syringomyelia - a fluid-filled cavity within the spinal cord - is uncommon but clinically significant, as it can worsen neurological deficits. Understanding and managing this association remain challenging, especially in elderly patients.

CASE PRESENTATION: A 73-year-old male farmer presented with a 6-month history of progressive lower limb weakness and sensory loss, progressing to paraplegia and sphincter dysfunction. Neurological examination revealed complete bilateral lower limb paralysis (0/5), absent reflexes, and hypoesthesia below the left knee. Magnetic resonance imaging (MRI) demonstrated a long-segment intramedullary lesion extending from T4 to T12 with cranial and caudal syringomyelia. Differential diagnoses included astrocytoma and ependymoma. The patient underwent multilevel laminectomy (T4-T12) and microsurgical tumor resection. A yellowish-gray intramedullary mass was identified, and piecemeal gross total resection was achieved. Histopathology confirmed WHO Grade II astrocytoma. At 2 months follow-up, the patient showed partial neurological recovery (right leg 2/5, left leg 1/5) and continued physiotherapy.

CLINICAL DISCUSSION: Thoracic intramedullary astrocytoma associated with syringomyelia is exceptionally rare, particularly in older adults. Surgical intervention remains the cornerstone of management, although complete resection can be technically demanding due to the infiltrative nature of the tumor and the risk of neurological injury. In this case, meticulous microsurgical technique enabled gross total removal with partial neurological improvement. Recognition of tumor-syrinx coexistence and appropriate decompression are crucial to prevent further neurological decline and to improve postoperative recovery.

CONCLUSION

This case emphasizes the rarity of thoracic intramedullary astrocytoma associated with syringomyelia. Gross total resection can be safely achieved with careful microsurgical dissection, leading to functional stabilization and improved quality of life. Early diagnosis and multidisciplinary management are key to optimizing outcomes in such complex spinal cord lesions.