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

Abstract

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.

Outcome predictors in the management of spinal cord ependymoma

“…Advances in surgical technique and the routine use of corticosteroids has lead to reduced morbidity and mortality, however, the role of adjuvant radiotherapy after spinal ependymoma surgery remains unclear. Some authors have suggested post-operative radiotherapy following complete excision [13,19,21], whilst many feel that adjuvant therapy is unnecessary after complete excision [1,2,6]. When technical reasons prevent complete excision or in cases with metastatic spread, radiotherapy is advocated [4,8], however, concerns that radiotherapy may cause reactive gliosis and fibrosis making re-operation for recurrence technically difficult [10], and concern about long-term radiation myelopathy leading to severe neurological dysfunction [16,22] have limited its use in some centres.…”

Cervical decompression and reconstruction without intraoperative neurophysiological monitoring

“…1,11,15,19,34,42 Many developments have occurred since IOM was first used, 8 and currently SSEPs are used to assess the dorsal afferent tracts, 35 while MEPs are used for monitoring the motor tracts of the spinal cord. The utility and accuracy of each monitoring modality may be affected by the type of surgery, patient condition, anesthesia, and physiological changes during surgery.…”

Chromosomal Abnormalities Subdivide Ependymal Tumors into Clinically Relevant Groups

“…Several studies have identified extent of resection as an important variable. [1][2][3][4][5][6][7][8][9] Young age at diagnosis is a poor prognostic factor, although a clear explanation for this observation has not been proposed. …”