Clinical features and microsurgical treatment of intramedullary spinal cord ependymomas

Abstract

Objective To analyze the clinical features and microneurosurgical management of intramedullary spinal cord ependymomas. Methods Sociodemographic characteristics, diagnosis and treatment of 51 patients with intramedullary spinal cord ependymomas treated in Southwest Hospital between January 2003 to January 2013 were reviewed. Results Of the 51 patients, the ratio of male and female was 1.32∶1 (29 males, 22 females). The onset age ranged from 8 to 68 years old, with the average age of 39.21 years. The main symptoms included pain in 41 cases, numbness in 35 cases, hypodynamia in 22 cases, dyspnea in 6 cases and incontinence in 5 cases. The first symptom was pain in 28 cases, numbness in 16 cases and hypodynamia in 9 cases. According to McCormick spinal function scale, 3 cases of the 51 patients were gradeⅠ, 33 cases grade Ⅱ, 11 cases grade Ⅲ and 4 cases grade Ⅳ. Among all the tumors, 3 cases were located in medulla-cervical cord, 24 in cervical spinal cord, 7 in cervical-thoracic spinal cord, 13 in thoracic spinal cord, 2 in thoracic-lumbar spinal cord and 2 in lumbar spinal cord. All patients underwent microsurgical procedure and total excision was achieved in 42 cases (82.35%), subtotal in 7 cases (13.73% ) and partial resection in 2 cases (3.92% ). Postoperative neurological function was improved in 33 patients, while no changes occurred in 14 cases and became worsened in 3 cases. One case died of secondary edema in the upper part of cervical spinal cord. Twenty-nine patients were followed-up from 5 months to 10 years (mean 41.83 months). Eight cases of the 29 patients were McCormick gradeⅠ, 14 cases gradeⅡ, 5 cases gradeⅢ and 2 grade Ⅳ. Conclusion Microneurosurgical procedure was the fundamental measure in treatment of intramedullary spinal cord ependymomas. Preoperative neurological function, tumor adhesion and surgical technique were the major factors influencing prognosis. doi：10.3969/j.issn.1672-6731.2013.12.005 Video: http://www.cjcnn.org/index.php/cjcnn/pages/view/v13n12a5