Multisegmental versus monosegmental intramedullary spinal cord ependymomas: perioperative neurological functions and surgical outcomes.

Chenlong Yang,Jian Wu,Bin Liu,Jingcheng Xie,Qing Chang,Jun Yang,Changcheng Ma,Haibo Wu,Xiaodong Chen,Mei Zheng,Tao Wang,Jianjun Sun

doi:10.1007/s10143-021-01567-5

Abstract

Multiple factors, such as tumor size, lateralization, tumor location, accompanying syringomyelia, and regional spinal cord atrophy, may affect the resectability and clinical prognosis of intramedullary spinal cord ependymomas. However, whether long-segmental involvement of the spinal cord may impair functional outcomes remains unclear. This study was aimed to compare perioperative neurological functions and long-term surgical outcomes between multisegmental ependymomas and their monosegmental counterparts. A total of 62 patients with intramedullary spinal cord ependymoma (WHO grade II) were enrolled, and all of them underwent surgical resection. The patients were classified into the multisegmental group (n = 43) and the monosegmental group (n = 19). Perioperative and long-term (average follow-up period, 47.3 ± 21.4months) neurological functions were evaluated using the modified McCormick (mMC) scale and the modified Japanese Orthopaedic Association (mJOA) scoring system. Preoperative neurological functions in the multisegmental group were significantly worse than those in the monosegmental group (P < 0.05). However, postoperative short-term neurological functions, as well as long-term functional outcomes, were similar between the two groups (P > 0.05). Logistic regression analysis showed that preoperative mMC and mJOA scores were significantly correlated with neurological improvement during the follow-up period (P < 0.05). Multisegmental involvement of the spinal cord is associated with worse neurological functions in patients with intramedullary spinal cord ependymoma, while the long-term prognosis is not affected. The preoperative neurological status of the patient is the only predictor of long-term functional improvement.

Highlights

Spinal intramedullary tumors are relatively rare, accounting for approximately 4%~10% of all central nervous system tumors and 20% of all intraspinal neoplasms [21]
Multisegmental involvement of the spinal cord is associated with worse neurological functions in patients with intramedullary spinal cord ependymoma, while the long-term prognosis is not affected
The preoperative neurological status of the patient is the only predictor of long-term functional improvement

Summary

Introduction

Spinal intramedullary tumors are relatively rare, accounting for approximately 4%~10% of all central nervous system tumors and 20% of all intraspinal neoplasms [21]. The advances in microneurosurgery and intraoperative neuroelectrophysiological monitoring have greatly improved the safety of surgical removal of spinal intramedullary tumors. Maximal safe surgical resection has been recommended as the first-line regimen for the treatment of spinal ependymomas [6,13]. Multiple factors, such as tumor size, lateralization, tumor location, accompanying syringomyelia, and regional spinal cord atrophy, have been identified to affect the resectability and clinical prognosis of intramedullary spinal cord ependymomas [4,11,20,25]. Some scholars proposed that patients with longsegmental ependymomas may have a significantly higher risk for postoperative neurological deterioration in comparison with patients with short-segmental lesions; the tumor extension (1-3 segments vs. > 3 segments involved) did not influence the resection rate [1]

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