Adult intramedullary spinal cord ependymomas: the result of surgery in 38 patients

Epstein, Fred J.; Farmer, Jean‐Pierre; Freed, Diana

doi:10.3171/jns.1993.79.2.0204

Cited by 275 publications

(194 citation statements)

References 16 publications

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“…Previous single-institution series have almost exclusively focused on the description, prevention and management of neurologic complications. [8][9][10][11][12][13][14] Our study demonstrates the significant negative impact of mostly nonneurologic complications on patient outcomes. Therefore, avoidance, recognition and prompt management of neurologic as well as nonneurologic postoperative complications is extremely important in the successful surgical management of patients with spinal tumors.…”

Section: Discussionmentioning

confidence: 87%

“…Previous single-institution series have reported postoperative complication rates of 11-64% with generally higher complication rates after resection of astrocytomas compared to ependymomas. [8][9][10][11][12][13][14] The NIS data do not afford distinction between the different pathologic types of spinal cord tumors and hence, we cannot comment on the complication rates after resection of astrocytomas versus ependymomas. Furthermore, the 17.5% complication rate we report in our study is likely an underestimate of the true complication rate because only select complications were examined.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the limitation of the NIS dataset, other previously reported factors such as tumor pathology, grade, preoperative neurologic status and extent of tumor resection that predict outcome could not be evaluated in this analysis. 2,9,10,12 Also, this analysis contains only inpatient outcomes and cannot comment on long-term outcomes or recurrences. Nonetheless, this is the first study to report morbidity, mortality and the effect of postoperative complications on resource utilization on a national level for surgically treated spinal cord tumors.…”

Section: Discussionmentioning

confidence: 99%

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Complications and outcomes after spinal cord tumor resection in the United States from 1993 to 2002

Patil

Lad

et al. 2007

Spinal Cord

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Study design: Retrospective cohort study. Objective: Data on patient outcomes after surgery for spinal cord tumors have been derived from single-institution series. The objective of this study is to report inpatient complications, mortality and outcomes on a national level. Setting: United States, national inpatient care database. Methods: The National Inpatient Sample (NIS) was used to identify 19 017 admissions for resection of a spinal cord tumor in the United States from 1993 to 2002. The effects of patient and hospital characteristics on inpatient outcomes were analyzed using logistic regression. Results: The in-hospital mortality rate and the complication rate were 0.55 and 17.5%, respectively. Urinary and renal complications (3.7%), postoperative hemorrhages or hematomas (2.5%) and pulmonary complications (2.4%) were the most common complications reported. A single postoperative complication increased the length of stay by 4 days, increased the mortality rate by sixfold and added over $10 000 to hospital charges. Multivariate analysis showed that complications were more likely in African Americans and patients with multiple comorbidities. The odds of an adverse outcome increased significantly with age greater than 64, multiple comorbidities and postoperative complications. Conclusion: A national perspective on inpatient outcomes after resection of spinal cord tumors has been provided. The significant negative impact of postoperative complications on mortality and resource utilization has been demonstrated. We have identified advanced age and multiple comorbidities as risk factors that predict adverse outcome. Furthermore, this study highlights the importance of avoidance, recognition and prompt management of nonneurologic complications.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Complications and outcomes after spinal cord tumor resection in the United States from 1993 to 2002

Patil

Lad

et al. 2007

Spinal Cord

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“…Gross total resection (GTR) has been established as the gold standard in the treatment of intramedullary ependymoma, with series reporting 70-100% of ependymomas being radically resected [6,16,20,45,57] and long-term survival being the rule rather than exception. On the contrary, the therapeutical spectrum in infiltratively growing intramedullary astrocytomas ranges from histological verification and decompressive surgery with subsequent radiotherapy [64] to GTR, with 6-70% of intramedullary astrocytomas undergoing GTR [27,28,34,49,56,58,61,64].…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors in intramedullary astrocytomas: a literature review

2009

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Astrocytomas affect a significant portion of patients with intramedullary tumors. These infiltratively growing tumors are treated by a variety of methods-biopsy and decompressive surgery, maximal safe resection, adjuvant oncological therapy. Also, numerous prognostic factors are reported in the literature. Better understanding of factors that influence prognosis may help in treatment planning with the goal of prolonging survival. We have thus undertaken an extensive literature review in order to define factors affecting prognosis. A total of 38 articles were studied. Only tumor grade was consistently reported as the major factor affecting prognosis. The influence of other clinical factors (age, gender, history length, functional status, tumor location or extent, syrinx or cyst presence) can be speculated upon, but cannot be assessed adequately from the available literature. For both low-and high-grade (HG) astrocytomas, maximal safe tumor resection should be the primary treatment objective but is often not feasible in contrast to other intramedullary and spinal neoplasms. Since the biological nature of spinal cord HG glioma is identical to that of the brain, the same treatment algorithm of maximal safe resection followed by concomitant radio-and chemotherapy would be sensible to implement.

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“…11,12,20 ± 23 Mork et al 3 have reported that the 10-year survival rate was no di erent in patients treated with surgery alone than in those with additional radiation therapy. Peschel et al 22 have recommended postoperative radiotherapy for the patients who had both total and subtotal resection, while Epstein et al 24 have advocated that radiation therapy was not a necessary adjunct following gross total removal of the tumor. In our series, seven patients including three patients who had total tumor removal received postoperative radiation; however, at present it is considered to be unnecessary for patients with complete resection.…”

Section: Discussionmentioning

confidence: 99%

Ependymomas of the spinal cord and cauda equina: An analysis of 26 cases and a review of the literature

Asazuma

Toyama

Suzuki³

et al. 1999

Spinal Cord

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Study design: Retrospective review. Objectives: To clarify the clinical features of patients with spinal ependymomas and to compare the clinical results between the patients in whom microsurgical technique and spinal cord monitoring were used intraoperatively and the patients in whom they were not used. Setting: Keio University Hospital, Tokyo, Japan. Methods: Twenty-six consecutive patients with spinal ependymomas were treated surgically between 1958 and 1995. All patients underwent tumor resection through a posterior approach. Complete tumor resection was possible in 15 patients (57.7%), and subtotal tumor resection (more than 90%) was done in two patients (7.7%). Only a partial tumor resection (less than 90%) was performed in the remainder of the patients (34.6%). The operative results of the patients were evaluated by the Japanese Orthopaedic Association Scoring System (JOA score) and its recovery rate. Results: The overall average recovery rate was 18.3%. The mean recovery rate was 14.4% in cervical lesion, 11.1% in thoracic lesion and 40% in lumbar lesion. The recovery rate of eight patients with cervical ependymomas who underwent tumor resection under both microscopic surgical procedure and intraoperative spinal cord monitoring was 37.1% although the recovery rate of the rest of the patients was 71.6%. There was a statistical di erence between the two groups (P50.02). The survival rate of patients following complete excision was statistically better compared to that of patients after incomplete resection. Conclusion: Both microsurgical technique and spinal cord monitoring are indispensable to achieve total removal of ependymomas and to obtain improvement of neurological recovery.

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Adult intramedullary spinal cord ependymomas: the result of surgery in 38 patients

Cited by 275 publications

References 16 publications

Complications and outcomes after spinal cord tumor resection in the United States from 1993 to 2002

Complications and outcomes after spinal cord tumor resection in the United States from 1993 to 2002

Prognostic factors in intramedullary astrocytomas: a literature review

Ependymomas of the spinal cord and cauda equina: An analysis of 26 cases and a review of the literature

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