Surgery not tolerated: When spinal cord function does not allow sufficient resection as demonstrated by IOM, then adjunctive therapy is considered. Typically, this is in the setting where continued growth in the tumor after a partial resection threatens further loss of function. It is rare to use multimodality treatments at the time of initial management unless the tumor is anaplastic.
Radiotherapy: The efficacy of radiotherapy in the treatment of intramedullary spinal cord astrocytomas is well proven while its usefulness in treating other tumors is not established (26).
Chemotherapy: The efficacy for chemotherapy in managing intramedullary spinal cord tumors has not been proven.
Benign tumor: A yearly visit including a follow-up MRI study is typically done for these tumors. The frequency will decrease with time but a schedule should probably be established for the life of the patient.
Malignant tumor: Children with a malignant IMSCT are usually followed by a multidisciplinary neuro-oncology team who will have a protocol in place for following their patients with malignant CNS tumors. Visits and MRI scans will typically be every 3-6 months.