Gross total resection rates of grade II/III intramedullary ependymomas using the surgical strategy of <i>en-bloc</i> resection without intra-operative neurophysiological monitoring

Sweeney, Kieron; Reynolds, Matt; Farrell, Michael; Bolger, Ciarán

doi:10.1080/02688697.2016.1270419

Cited by 17 publications

(9 citation statements)

References 20 publications

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“…We found that IONM was used in 80% and was missing in 10 cases with intramedullary tumors. This is in line with recently published data on use (46) or non-use of IONM (47). At our institution, one senior neurophysiologist attends all surgeries with IONM.…”

Section: Discussionsupporting

confidence: 92%

Surgical Treatment of Intra- and Juxtamedullary Spinal Cord Tumors: A Population Based Observational Cohort Study

et al. 2019

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Objective: Intramedullary spinal cord tumors (IMSCT) are rare entities and high-level evidence regarding optimal treatment is lacking. We aim to describe the demographics, histopathological distribution, onset symptoms, treatment strategies, and functional outcome for patients surgically treated for IMSCT. Methods: We performed a retrospective review of a consecutive population-based cohort of 95 patients who underwent surgery for intra- or juxtamedullary tumors at a single institution during the period 2004–2017. Results: When gross total resection (GTR) was achieved, we found no case of local tumor recurrence even in the absence of adjuvant radio- or chemotherapy. Meanwhile, we found a 50% progression rate on long-term MRI follow-up in patients where only a partial resection was possible. At long-term follow-up, there was no significant alteration in functional status, while a significant reduction in share of patients reporting pain, compared to preoperative status, was identified. Poor preoperative functional status and postoperative tumor remnant were identified as individual risk factors for further functional decline. Conclusion: Gross total resection, with minimal post-operative neurological deterioration, is possible in the majority of the cases, especially in the presence of an identifiable resection plane between tumor and healthy spinal cord. Since long-term progression-free survival could be achieved by GTR without additional adjuvant treatment, we emphasize that low-grade tumors should not be subject to radiotherapy. Treatment of high-grade or diffusely infiltrating tumors, tumor remnants, or metastases should be individualized.

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Section: Discussionsupporting

confidence: 92%

Surgical Treatment of Intra- and Juxtamedullary Spinal Cord Tumors: A Population Based Observational Cohort Study

et al. 2019

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“…Further efforts are required to identify the most valid and reliable parameters that can guide surgery and predict led to a GTR rate of 94,12% (43), which is very similar to the rate we achieved.…”

Section: █ Conclusionsupporting

confidence: 72%

The impact of intraoperative monitoring on extent of resection and long-term neurological outcomes: a series of 39 intramedullary ependimomas.

Milićević

Solari²,

Illic³

et al. 2019

Turkish Neurosurgery

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To analyze the impact of intraoperative neurophysiological monitoring (IONM) on the extent of removal and long-term neurological outcomes in a series of grade II ependymomas. MATERIAL and METHODS: We retrospectively reviewed 88 consecutive patients who underwent surgical resection of an intramedullary spinal cord tumor (IMSCT) at the Clinic of Neurosurgery of the Clinical Center of Serbia in Belgrade between January 2012 and December 2017. In all, 39 patients (25 males and 14 females; mean age 46.16 years) with grade II ependymomas were enrolled in this study; the mean follow-up time was 49.84 months. The modified McCormick Scale (mMCS) was used to assess the short-and long-term outcomes, and the patients were divided into two groups based on whether they underwent IONM. RESULTS: The gross-total removal rate was 89.7%, and it was not influenced by use of IONM, location or tumor size. Upon admission,43.2% of the patients were dependent (grades IV and V), while 56.8% were independent (grades I, II and III), according to the mMCS. After 3 months of follow-up, 76.9% of the patients maintained or improved their neurological status, but this percentage was reduced after long-term follow-up. CONCLUSION: Total surgical resection with good neurological outcomes can be achieved in the vast majority of patients with grade II ependymomas; it is important to emphasize that the use of IONM allows acceptable extent of resection and provides better results in terms of functional outcomes, with lower morbidity rates. Therefore, no correlation was demonstrated between the decrease in the basal amplitudes of IONM and D-waves and poor neurological outcomes.

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“…25 Oh et al reported in their meta-analysis no difference in OS or PFS between MPE and grade II ependymoma. 15 Weber et al demonstrated a treatment failure rate of 33% in their series. 26 Surgically, this may be explained by the complexity of these lesions, which can be densely adherent, even appearing to be infiltrating the conus medullaris and/or cauda equina, making GTR in conjunction with neurologic preservation technically challenging.…”

Section: Intramedullary Spinal Cord Ependymomamentioning

confidence: 99%

“…14 The ability to achieve GTR for intramedullary grade II ependymomas can be as high as 93% while being safely performed in most patients. [15][16][17] GTR is facilitated in characteristically well-defined and encapsulated World Health Organization (WHO) Grade I tumors; however, this is less likely in infiltrative grade II and the more aggressive grade III ependymomas. 18 Whenever possible, intramedullary ependymomas should be removed en bloc, as piecemeal removal may facilitate CSF dissemination.…”

Section: Intramedullary Spinal Cord Ependymomamentioning

confidence: 99%

Case-based review: ependymomas in adults

Cachia

Johnson

Kaufmann

et al. 2018

Neuro-Oncology Practice

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Ependymomas are rare primary central nervous system (CNS) tumors in adults. They occur most commonly in the spinal cord, and have classically been graded histologically into World Health Organization (WHO) grades I, II, or III based on the level of anaplasia. Recent data are showing that genetic heterogeneity occurs within the same histological subgroup and that ependymomas arising from different CNS locations have different molecular signatures. This has renewed interest in developing targeting therapies based on molecular profiles especially given the variable outcomes with radiation and the poor results with cytotoxic agents. In this paper, we present the case of a 46-year-old woman with a classic presentation of spinal cord ependymoma and discuss the current histopathological and molecular classification for ependymomas as well as current guidelines for patient management.

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Gross total resection rates of grade II/III intramedullary ependymomas using the surgical strategy of en-bloc resection without intra-operative neurophysiological monitoring

Cited by 17 publications

References 20 publications

Surgical Treatment of Intra- and Juxtamedullary Spinal Cord Tumors: A Population Based Observational Cohort Study

Surgical Treatment of Intra- and Juxtamedullary Spinal Cord Tumors: A Population Based Observational Cohort Study

The impact of intraoperative monitoring on extent of resection and long-term neurological outcomes: a series of 39 intramedullary ependimomas.

Case-based review: ependymomas in adults

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