Surgical outcome and prognostic factors in spinal cord ependymoma: a single-center, long-term follow-up study.

Oliver Gembruch,Philipp Dammann,Yahya Ahmadipour,Mehdi Chihi,Ulrich Sure,Merle Haarmann,Ramazan Jabbarli,Marvin Darkwah Oppong,Laurèl Rauschenbach,Neriman Özkan,Anna Michel,Ahmet Parlak

doi:10.1177/17562864211055694

Oliver Gembruch, Philipp Dammann + Show 10 more

Open Access

https://doi.org/10.1177/17562864211055694

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Abstract

Objective:Spinal cord ependymomas account for 3–6% of all central nervous system tumors and around 60% of all intramedullary tumors. The aim of this study was to analyze the neurological outcome after surgery and to determine prognostic factors for functional outcome.Patients and Methods:Patients treated surgically due to a spinal cord ependymoma between 1990 and 2018 were retrospectively included. Demographics, neurological symptoms, radiological parameters, histopathology, and neurological outcome (using McCormick Score [MCS]) were analyzed. Possible prognostic factors for neurological outcome were evaluated.Results:In total, 148 patients were included (76 males, 51.4%). The mean age was 46.7 ± 15.3 years. The median follow-up period was 6.8 ± 5.4 years. The prevalence was mostly in the lumbar spine (45.9%), followed by the thoracic spine (28.4%) and cervical spine (25.7%). Gross-total resection was achieved in 129 patients (87.2%). The recurrence rate was 8.1% and depended on the extent of tumor resection (p = 0.001). Postoperative temporary neurological deterioration was observed in 63.2% of patients with ependymomas of the cervical spine, 50.0% of patients with ependymomas of the thoracic spine, and 7.4% of patients with ependymomas of the lumbosacral region. MCS 1–2 was detected in nearly two-thirds of patients with cervical and thoracic spinal cord ependymoma 36 months after surgery. Neurological recovery was superior in thoracic spine ependymomas compared with cervical spine ependymomas. Poor preoperative functional condition (MCS >2), cervical and thoracic spine location, and tumor extension >2 vertebrae were independent predictors of poor neurological outcome.Conclusion:Neurological deterioration was seen in the majority of cervical and thoracic spine ependymomas. Postoperative improvement was less in thoracic cervical spine ependymomas compared with thoracic spine ependymomas. Poor preoperative status and especially tumor extension >2 vertebrae are predictors of poor neurological outcome (MCS >2).

Highlights

Spinal cord ependymomas are usually slow-growing tumors arising from ependymal cells of the central canal of the spinal cord.[1]
Study population A retrospective analysis of the electronic database ‘spinal neoplasm’ evaluating the clinical and radiological data and operative reports of patients suffering from a spinal ependymoma who attended to our department between 1990 and 2018 was performed
The surgical treatment of spinal ependymomas remains challenging, as postoperative neurological deterioration plays a key role in prognosis

Summary

Introduction

Spinal cord ependymomas are usually slow-growing tumors arising from ependymal cells of the central canal of the spinal cord.[1]. Symptom presentation is related to the tumor location and can include radicular or local pain, motor weakness of the extremities, hypoesthesia, gait disturbance, and sphincter or sexual dysfunction.[6,7,8] Non-specificity of symptoms can lead to adaptation to symptoms and late diagnosis. Cervical tumors can present symptoms of upper or lower extremities, due to the corticospinal tract or dorsal column being affected.[9] Symptom duration depends on tumor location and symptom characteristics, with back pain being the most common symptom. The average symptom duration described in the literature is around 2 years.[10,11,12] In rare cases, an acute deterioration of the symptoms can be provoked by intratumoral hemorrhage.[13,14,15]

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