Surgical Technique and Outcome in the Treatment of Spinal Ependymomas: A Retrospective Analysis of 23 Cases Treated

Abstract

Introduction Spinal ependymomas are from 3 to 6% of all tumors of the central nervous system and 15% of all spinal cord tumors. The WHO classifies ependymomas in the following four distinct subtypes: subependymoma, ependymoma myxopapillare, classic ependymoma, and anaplastic ependymoma. Spinal ependymomas are typically present in adults and include the following two subtypes: myxopapillary and classic. This review reports the data obtained on 23 patients treated for spinal ependymoma at our department of Neurosurgery from 2000 to 2012, describing the type of surgical treatment and clinical outcome with a mean follow-up of 4 years. Materials and Methods Among 53 cases of intramedullary tumors, 23 (43%) were ependymomas. The average age of patients with spinal ependymoma was 42.65 years with a range between 18 and 71 years. The main locations were cauda equina (70%), medullary cone (13%), and cervical region (13%). Neurological examination of each patient at the entrance, in the postoperative and last –follow-up was determined using the McCormick grading scales. All patients underwent surgical removal of the tumor and the McCormick grading was evaluated with multiple follow-up. The extent of resection and surgical results were evaluated with postoperative MRI. Results As evidenced in some tables, we performed gross-total removal (GTR) in 21 patients (91%) and subtotal removal (STR) in only 2 patients (9%). None of patient was treated with adjuvant radiotherapy and/or chemotherapy. There were no recurrences. No patient's follow-up showed signs of postoperative instability of the spine. Some particular surgical techniques in removal of this tumor are reported. Conclusion This study underlines some aspects of the surgical treatment of spinal ependymomas. Patients who underwent total removal had a clear neurological improvement. As evidenced in tables, patients who had McCormick II–III at the entrance improved significantly. To achieve good functional results, an early diagnosis and a prompt surgery are important. In case of a good surgical removal, postoperative radiotherapy is not indicated.