Surgical strategies of intramedullary medullocervical ependymomas: a report of 120 cases

Abstract

Objective To explore the clinical characteristics and microsurgical skills of intramedullary medullocervical ependymomas for increasing the rate of gross total resection (GTR) and decreasing the disabling rate. Methods A total of 120 patients with medullocervical ependymomas were admitted to Department of Neurosurgery, Changzheng Hospital, the Second Military Medical University of PLA, from January 2001 to November 2016. A retrospective analysis was conducted regarding their clinical manifestations, imaging characteristics, microsurgical manipulations, extent of resection and postoperative follow-up data. In all cases, the tumor resection was performed using posterior suboccipital midline approach. Results Among the 120 patients, GTR was achieved in 111 (92.5%) cases and subtotal resection was performed in 9 (7.5%) cases. The maximal tumor size was 25.0×2.0×2.0 cm and affected all cervical levels, and the minimal size of the tumor was 1.0×1.0×0.6 cm. Follow-up was successfully conducted in 106 (95.5%) patients and for 3 to 108 months with an average of (23.0±18.5) months. The patient's sensory and motor functions were relieved or remained unchanged post surgery in 83 (78.3%) cases and aggravated in 22 (20.8%) cases. One (0.9%) death occurred. Four patients (3.8%) were reoperated on due to tumor recurrence. The neurological function was graded based on the McCormick system as 60 (56.6%) cases in grade I, 28 (26.4%) cases in grade II, 16 cases (15.1%) in grade III and 1(0.9%) case in grade IV. Conclusion For most intramedullary medullocervical ependymomas, proper surgical strategies and qualified operational skills, combined with imaging and neuroelectrophysiological technologies could be applied to realize the GTR of tumors and preservation of neurological functions. Key words: Medulla oblongata; Spinal cord; Ependymoma; Microsurgery; Prognosis