Clinical features and treatment analysis of intracranial extraventricular ependymomas

Abstract

Objective To study the clinical features, imaging demonstration and treatment outcomes of intracranial extraventricular ependymomas. Methods A total of 17 patients with intracranial extraventricular ependymoma underwent surgical treatment at Department of Neurosurgery, Renmin Hospital of Wuhan University from March of 2010 to June of 2016 and were enrolled into this retrospective study. Pre-operative MR scan showed single lesion located at supratentorial region in all cases. Those lesions were located in occipital lobe (5 cases), occipitoparietal lobe (2 cases), temporal lobe (3 cases), frontal lobe (4 cases) and parietal lobe (3 cases). Among those, 7 were solid and 10 were cystic lesions. Surgical excision was performed for all lesions. Post-operative follow-up was performed for every patient through telephone and outpatient review. Results Of those cases, total resection was achieved in 15 cases, including 10 cases of WHO grade Ⅱ and 5 case of WHO grade Ⅲ, and partial resection in 2 (WHO grade Ⅲ). Intraoperative pathological diagnosis suggested that 10 cases were ependymoma (WHO gradeⅡ) and 7 cases were anaplastic ependymoma (WHO grade Ⅲ). All patients′ clinical symptoms were relieved following surgery. Four cases (grade Ⅲ), including 2 cases undergoing partial resection, received post-operative radiotherapy. The follow-up time of those patient were from 14 to 74 months, with a median of 33.2 months. During the follow-up, no case showed any signs of spinal cord metastasis. Recurrence was reported in 7 cases and 4 of them (grade Ⅲ) received post-operative radiotherapy. Among those, 1 case underwent the second tumor total resection and postoperative radiotherapy, 1 case died 3 months after the second tumor total resection, 2 cases of tumor partial resection rejected the second operation and died after 4 and 6 months, respectively, and the other 3 recurrent cases included 2 (grade Ⅱ) and 1 (grade Ⅲ) undergoing the second tumor total resection without postoperative radiotherapy and 1 (grade Ⅲ) that died of postoperative hemorrhage. Conclusions As intracranial extraventricular ependymoma has non-specific clinical and imaging features, accurate pre-operative diagnosis is difficult. Total tumor resection is the primary method of treatment, if it is possible. The choice of resection type and pathological grading could be predictive factors in postoperative evaluation. Key words: Ependymoma; Neurosurgical procedures; Treatment outcome; Intracranial extraventricular