Intracranial and spinal ependymoma: series at Faculdade de Medicina, Universidade de São Paulo

Abstract

-Objective: Ependymomas are rare intracranial neuroepithelial tumors and the most common location is intramedullary. The aim was to analyze the characteristics of these tumors to determine the patients' overall survival and the likelihood of recurrence. Method: Data of clinical presentation, tumor location, duration of symptoms, degree of resection and complementary treatment of 34 patients with intracranial ependymoma and 31 with intramedullary ependymoma who underwent surgery in the last ten years were collected and correlated with the recurrence time and overall survival. Results: There was statistically significant correlation between the degree of resection and intracranial tumor location, although it is not a hallmark of recurrence. Data analyses of intramedullary ependymoma did not show correlation with overall survival and likelihood of recurrence. Conclusion: The location of the intracranial tumor is connected with the degree of resection; however it is not a predictive factor to overall survival.KEy worDS: brain tumor, intramedullary tumor, ependymoma.ependimoma craniano e de medula espinhal: casuística da Faculdade de medicina da Universidade de são paulo resumo -Objetivo: os ependimomas são tumores neuroepiteliais raros na localização intracraniana, porém um dos mais freqüentes na medula espinhal. os autores analisaram as características destes tumores para determinar a sobrevida e probabilidade de recidiva nos pacientes. Método: Elementos da apresentação clínica, localização da lesão, duração de sintomatologia, grau de ressecção e tratamento complementar de 34 doentes com ependimoma intracraniano e 31 de medula espinhal operados nos últimos dez anos foram revisados e correlacionados com o período para a ocorrência da recidiva e a sobrevida. Resultados: Houve correlação estatística apenas entre o grau da ressecção e a localização dos ependimomas intracranianos, embora, este não se tenha mostrado um marcador de recidiva. A avaliação dos dados clínicos dos pacientes com ependimoma medular não permitiu definir correlação com a sobrevida e sobre a probabilidade de recorrência. Conclusão: A localização do tumor intracraniano está relacionada ao grau de ressecção, entretanto isso não foi um fator preditivo para a sobrevida.PAlAvrAS-cHAvE: tumor cerebral, tumor intramedular, ependimoma. overall, they account for 6-9% of the intracranial tumors. They are the third most common tumor in the youngest age group, representing 30% of the intracranial primary neoplasms in individuals with less than three years of age 3 . Intramedullary spinal ependymomas are more common in individuals with 15 to 40 years of the age, representing about 30% of the ependymomas of the central nervous system and 60% of the intramedullary tumors 4 . clinical presentation is non-specific and depends on

Prognosis by tumor location in adults with intracranial ependymomas

“…Our research group has previously reported, in parallel, on the prognostic significance of tumor location in adult spinal ependymomas using the same methodology and aggregated data [38]. However, the prognostic significance of tumor location, particularly in intracranial ependymomas, has been debated [39]. We found in the present study that the tumor location of intracranial ependymomas has significant prognostic consequences, as infratentorial location is a more favorable location than supratentorial with respect to PFS and OS in adults.…”

“…The opposite pattern, with supratentorial location conferring a more favorable prognosis, has been demonstrated for pediatric intracranial ependymomas [49]. Previous studies have reported conflicting findings as to the attainability of GTR for supratentorial versus infratentorial location [39, 50, 51], two of which suggested that supratentorial ependymomas may possess a more disseminative phenotype that precludes GTR from involved brain parenchyma. In children, supratentorial ependymomas have a higher mitotic activity than infratentorial types [52].…”

Prognosis by tumor location in adults with spinal ependymomas

“…Despite numerous studies done on spinal ependymomas, most studies are limited to experiences gathered from a single institution or a few institutions. 7,34,39,50,57 The goal of this study was to perform a comprehensive literature review with an integrative analysis (where the previously reported individual cas- es are pooled and analyzed) of spinal ependymoma in adult patients who underwent resection to better understand how spinal ependymomas behave differently along the spinal axis. This study is the largest integrative analysis of surgical outcomes in adult spinal ependymoma patients to date.…”

“…Although previous studies indicate that intracranial ependymomas behave differently from spinal ependymomas, 7,8,35,58,59,63 an extensive analysis of ependymoma behavior within the spinal cord has not been conducted. Understanding tumor behavior at different locations along the spinal cord with respect to PFS and OS, for example, could allow more accurate prognosis, tailored management, and better patient counseling.…”

Estudo das alterações na expressão gênica dos ependimomas

“…A duração dos sintomas até o diagnóstico pode variar de 1 mês a 3 anos, sendo, geralmente, de 3 a 6 meses nos tumores intracranianos e cerca de 3 anos nas lesões intramedulares (Schwartz and McCormick 2000;Reni, Gatta et al 2007;Andrade, de Aguiar et al 2009). …”