Postoperative Management of Primary Spinal Cord Ependymomas

Marco, A. Di; Griso, C.; Pradella, R.; Campostrini, Franco; Garusi, G. F.

doi:10.3109/02841868809093557

Cited by 40 publications

(15 citation statements)

References 17 publications

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“…10,29 It is widely accepted that the first-line therapy for spinal cord ependymoma is surgery. 3,4,6,7,9,13,15,16,[18][19][20]23,24,26,27,31,32,34,35,38,41,43 Modern microsurgical techniques have resulted in a greater percentage of GTRs. Although anaplastic ependymomas are more aggressive than classic ependymomas, Prayson et al 33 found that anaplastic ependymomas, like lower-grade ependymomas, tended to be well demarcated from the surrounding spinal cord, rather than diffusely infiltrative.…”

Section: Discussionmentioning

confidence: 99%

“…Distinct from lesions that result from dissemination of intracranial anaplastic ependymomas and recurrent or metastatic spinal anaplastic ependymomas, PSAEs have been described in the past only in case studies 5,11,22,30,32,39 or as part of a series of spinal cord ependymomas. 3,4,7,15,26,31,41,43 Accordingly, the clinical characteristics and treatment outcomes of PSAEs have not been emphasized and are less well understood than those of benign or classic ependymomas (WHO Grade II). Given the relative paucity of literature addressing the primary spinal anaplastic variant, we review our experience with these tumors, with analysis of their clinical presentation, radiographic imaging, surgery, complications, recurrence, and survival.…”

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confidence: 99%

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Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients

Liu

Sun²,

Qi³

et al. 2013

SPI

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Object Little is known regarding the anaplastic variant of primary ependymomas that involve the spinal cord. The aim of this study was to evaluate the clinical characteristics and treatment outcomes of primary spinal anaplastic ependymomas (PSAEs). Methods Medical records were reviewed in 20 patients with pathologically proven PSAEs who underwent surgical treatment at the Department of Neurosurgery in Huashan Hospital between 1999 and 2008. Results This series included 7 women and 13 men between the ages of 2 and 67 years (mean 31.9 years). The mean preoperative course was 9.3 months (range 20 days to 48 months). The most common PSAE locations were the cervical and thoracic spinal cords. The most common presenting symptom was weakness, followed by numbness, bowel or bladder dysfunction, and pain. Gross-total resection (GTR) was achieved in 17 patients, and a subtotal removal was performed in 3 patients. Nine patients received radiation therapy and/or chemotherapy. The mean follow-up duration was 83.5 months. Functional assessment of the 10 patients available at the latest follow-up evaluation showed that 2 had worsened and 8 remained unchanged from their preoperative status. There were 2 local recurrences and 1 lung metastasis. Conclusions Patients with PSAEs presented with a much shorter preoperative course than patients with Grade II ependymomas in previous studies. Patients with tumors that involved the cervical spinal cord experienced a worse outcome. Surgical removal of PSAEs, with the goal of GTR, is beneficial to patients. The role of radiation therapy and chemotherapy in PSAEs remains to be determined in further studies.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients

Liu

Sun²,

Qi³

et al. 2013

SPI

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“…42 Neither study provided statistical analyses stratified by tumor grade. In the adult literature, the role of adjuvant radiation in the management of spinal ependymomas is also a matter of debate: some studies recommend postoperative radiation therapy in cases of STR but not GTR, 18,40,41,65,66 others advocate for postoperative radiation therapy after GTR, 38 and some maintain that radiation is not indicated regardless of degree of resection. 20,26,42 Further studies are needed to determine the optimal management of these rare tumors.…”

Section: Surgery and Adjuvant Radiation Therapymentioning

confidence: 99%

“…7,42,62 Maximal resection is generally agreed to be the cornerstone of treatment for pediatric spinal ependymomas; 2,7,8,34,42,47,50 however, the addition of adjuvant radiation therapy after surgery is the subject of more debate. 2,7,8,48 While there are many studies on spinal ependymomas in adults, 11,12,[16][17][18]21,24,25,38,41,45,51,56,57,61,65 there are few papers on these tumors in children, and those that do exist tend to be small, single-institution retrospective studies that are not powered for statistical analysis stratified by tumor grade. 2,8,13,22,27,42,47,53 The goal of this paper is to use the nationally representative Surveillance Epidemiology and End Results (SEER) database to offer a population-based perspective on pediatric Grade II spinal ependymomas.…”

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confidence: 99%

Treatment of pediatric Grade II spinal ependymomas: a population-based study

Lin

Jea

Melkonian

et al. 2015

PED

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OBJECT Grade II spinal cord ependymomas occurring in pediatric patients are exceptionally rare neoplasms. In this paper the authors use a national cancer database to determine patient demographics, treatment patterns, and associated outcomes of this cohort. METHODS The Surveillance Epidemiology and End Results (SEER) database was used to analyze subjects younger than 18 years with histologically confirmed diagnoses of Grade II spinal cord ependymoma from the years 1973 to 2008. Descriptive data on the demographic characteristics of this cohort and the associated treatment patterns are shown. The Kaplan-Meier method was used to estimate overall survival at 1, 2, 5, and 10 years. RESULTS This cohort comprised 64 pediatric subjects with Grade II spinal ependymoma. The median age was 13 years, nearly half of the patients were male, and most were white (84%). The median follow-up was 9.2 years. Overall survival at 5 and 10 years was 86% and 83%, respectively. Gross-total resection was achieved in 57% of subjects, and radiation therapy was administered to 36%. Radiation therapy was administered to 78% of subjects after subtotal resection but only to 19% of patients after gross-total resection; this difference was significant (p < 0.001). In a multivariate regression model analyzing sex, age at diagnosis, year of diagnosis, radiotherapy, and extent of resection, female sex was found to be an independent predictor of decreased mortality (HR 0.15 [95% CI 0.02–0.94], p = 0.04). CONCLUSIONS These data show long-term outcomes for pediatric patients with Grade II spinal ependymoma. Radiotherapy was more likely to be administered in cases of subtotal resection than in cases of gross-total resection. Female sex is associated with decreased mortality, while other demographic or treatment modalities are not.

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“…Whereas the traditional attitude does not support the use of extensive surgery, but only a single biopsy or dural decompression followed by radiotherapy [27,31], at the present time a growing number of authors advocate aggressive surgical management, which seems to improve local control and survival [8,[16][17][18][19]21]. This was first achieved with ependymomas: most authors reported the difference in the subsequent course between patients with total removal of the tumor and those with subtotal or partial resection, with a high recurrence rate in those with incomplete removal [10,13,23,33,41]. Although conclusions are more controversial for astrocytomas, which constitute tumors more often infiltrating than displacing the surrounding neural tissue, several investigators agree that radical excision is associated with better long-term prognosis, when carried out before there is significant disability [8, 16-19, 21, 45].…”

Section: Discussionmentioning

confidence: 99%

Direct Spinal Cord Electrical Stimulations during Surgery of Intramedullary Tumoral and Vascular Lesions

Duffau

Laurent

Sichez³

1998

Stereotact Funct Neurosurg

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Despite the use of somatosensory evoked potentials during surgery for spinal cord tumors or vascular lesions, postoperative neurological disorders, particularly motor deficits, frequently occur after aggressive surgery with an attempt of gross total resection. We report the use of peroperative direct spinal cord electrical stimulation to decrease morbidity while improving the quality of resection. Three patients with intramedullary lesions (1 ependymoma and 2 cavernomas), initially revealed by pain and followed by neurological deficit, were operated at our institution using peroperative direct medullary electrical stimulations (60 Hz, biphasic square wave pulses with 1 ms/phase, 0.9 mA) under general anesthesia without curare. In all cases, gross total resection was performed until motor responses to stimulation, which indicated anterior and lateral boundaries between the lesion and the functional tissue, were obtained. There was no postoperative neurological worsening, but an immediate partial improvement of sensory and bladder disorders in the patient with ependymoma. Postoperative MRI confirmed total resection in the 3 patients. These cases demonstrate that direct medullary electrical stimulation is a safe, easy, precise and reliable method to reduce morbidity during spinal cord surgery.

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Postoperative Management of Primary Spinal Cord Ependymomas

Cited by 40 publications

References 17 publications

Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients

Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients

Treatment of pediatric Grade II spinal ependymomas: a population-based study

Direct Spinal Cord Electrical Stimulations during Surgery of Intramedullary Tumoral and Vascular Lesions

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