Surgical treatment of spinal ependymomas

Abstract

Introduction Spinal ependymom as are rare tumors and present mainly around 40 years of age. Total resection is claimed to be the best option for the treatment, but it carries some risk and it needs good evaluation and may be some proper facilities to get satisfactory results. Aim The aim of this study was to investigate the surgical strategies and outcomes for spinal ependymomas of different lengths and locations. We present our surgical experience in Al-Zahraa University Hospital (Al-Azhar University) for managing spinal cord ependymomas. Patients and methods We report the results of eight patients over a 2-year period (2016–2018). All cases were managed in Al-Zahraa University Hospital. Surgery was recommended for all patients who have symptoms. Preoperative and postoperative clinical assessments were done for all cases. Results There were six men and two women. The mean age was 36.4 years (range, 24–60 years). The follow-up period ranged from 1 month to 2 years. Gross total resection was done in six (75%) cases. Near-total resection was done in one case, and partial resection was done in one cervical case. The overall postoperative complications rate was 12%. Seven of the eight cases improved clinically. Pain improved in seven (87.5%) cases. All three cases with weakness improved within the first week of surgery or during the first 6 months (postoperative follow-up period). Sphincters improved in three out four cases that had been presented with sphincters. Conclusion Most spinal ependymomas can be managed by gross total resection without significant morbidity. Neurological deficit occurred more in tumors that extend more than two spinal levels. Some cases have early postoperative neurological functions declination, but these cases improved during follow-up. It is better to use neurophysiological monitoring, but it is not essential for achieving good outcome.