Spinal cord ependymomas: a retrospective analysis of 59 cases

Waldron, John; Laperrière, Normand; Jaakkimainen, Liisa; Simpson, W.; Payne, David G.; Milosevic, Michael; Wong, C. Shun

doi:10.1016/0360-3016(93)90231-j

Cited by 126 publications

(89 citation statements)

References 23 publications

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“…8 The overall 5-year survival rate of the spinal ependymomas was reported to be between 57 and 90%. 3,11,12,14 The overall 5-year survival rate was 70% in our study, it was similar to the previous reports. The survival rate of patients following complete excision was statistically better compared to that of patients after incomplete resection in our study as Whitaker et al 11 demonstrated.…”

Section: Discussionsupporting

confidence: 92%

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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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Section: Discussionsupporting

confidence: 92%

“…According to the literature, the average duration of symptoms preceding diagnosis was 13 months to 8.3 years. 7,8,12 Despite the sensitivity of MRI, preoperative symptom duration remains characteristically long. 8 The overall 5-year survival rate of the spinal ependymomas was reported to be between 57 and 90%.…”

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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“…Recently, a number of smaller series have reported positive outcomes in children 20,27,28,[35][36][37][38][39][40] or adults 15 with totally resected Grade 2 intracranial ependymoma who did not receive RT after surgery. Reserving RT for recurrent disease appears to be an attractive strategy for patients with Grade 2 ependymoma, provided that the behavior of this malignancy is similar to that of lowgrade glioma, in which no detrimental impact on OS was observed when a 'wait and see' policy was followed after surgery.…”

Section: Treatmentmentioning

confidence: 99%

A multicenter study of the prognosis and treatment of adult brain ependymal tumors

Reni

Brandes

Vavassori

et al. 2004

Cancer

106

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BACKGROUNDThe current analysis of outcomes in a large series of adult patients with intracranial ependymal tumors contributes to the characterization of the primary prognostic factors and to the therapeutic management of this rare disease, for which limited information is available in the literature.METHODSThe authors analyzed data on patient and tumor characteristics, treatment, and survival in a series of 70 patients age > 17 years with pathologic diagnoses of brain ependymal tumors from 4 institutions.RESULTSThe 5‐ and 10‐year overall survival (OS) rates (± standard errors) were 67% ± 6% and 50% ± 8%, respectively. The 5‐ and 10‐year failure‐free survival (FFS) rates were 43% ± 7% and 24% ± 6%, respectively. Younger age and infratentorial tumor location were associated with longer survival. Among patients with Grade 2 ependymoma (n = 51), 21 (41%) received no postsurgical treatment. These 21 patients had a 5‐year OS rate of 78% ± 10% and a 10‐year OS rate of 68% ± 13%; the 5‐ and 10‐year FFS rates for these patients were 47% ± 12% and 12% ± 11%, respectively. Twenty‐six patients with Grade 2 ependymoma (51%) received postoperative radiotherapy (RT). These 26 patients had a 5‐year OS rate of 71% ± 9% and a 10‐year OS rate of 59% ± 11%; the 5‐ and 10‐year FFS rates for these patients were 54% ± 10% and 34% ± 10%, respectively. Among patients with Grade 2 ependymoma, neither OS nor FFS differed significantly between those who did not receive postoperative RT and those who did; however, these two groups were heterogeneous with respect to prognostic factors. On multivariate analysis, RT use exhibited a trend toward improved OS and was significantly predictive of improved FFS.CONCLUSIONSThe current analysis does not rule out the possibility that deferral of RT at the time of recurrence could have a detrimental effect on FFS or OS in patients with Grade 2 ependymoma, regardless of the degree of ablation. The role of postoperative RT for patients who undergo imaging‐based macroscopic total resection remains to be addressed. Cancer 2004. © 2004 American Cancer Society.

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“…5 The degree of surgical resection has been shown to significantly alter the survival in spinal cord ependymoma. 4,5,11 However, that is controversial for MPE. In the landmark paper by Sonneland et al, 2 less recurrence (10%) was observed with gross total removal of encapsulated tumors when compared with those removed in piecemeal (34% recurrence) or subtotally resected tumors (41% recurrence).…”

Section: Discussionmentioning

confidence: 99%

Myxopapillary ependymoma: correlation of clinical and imaging features with surgical resectability in a series with long-term follow-up

et al. 2011

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Study design: Retrospective case series. Objectives: The objective of this study is to identify imaging and intraoperative characteristics that may predict surgical resection for myxopapillary ependymoma (MPE). The diffuse involvement in the conus-filum region makes complete resection challenging. The preoperative characteristics that may estimate the extent of resection has not been reported. Setting: Toronto, Canada. Methods: All MPE cases between 1972 and 2005 at a single institution were identified and reexamined by a neuropathologist. Neurological outcomes (Frankel scale), clinical features, operative findings, pre and postoperative imaging results were reviewed. Results: A total of 18 operations were performed on 15 MPE patients (8 females/7 males; age range: 18-71 years). Median postoperative follow-up was 56 months. Three patients (17%) developed tumor regrowth requiring reoperations. Preoperative magnetic resonance imaging (MRI; in 14/18 procedures) determined that tumors involved the conus in 70% of cases, which was significantly associated with intraoperative findings (P ¼ 0.02). Complete microsurgical resection was accomplished in 4 out of 7 cases where conus was not involved, but in only 1 out of 10 cases with conus involvement (P ¼ 0.056). The degree of conus involvement in one case was unclear. None of patients with total surgical resection developed recurrence. All patients survived at long-term follow-up. Conclusion: Our series is the first to correlate MPE involvement to conus medullaris on preoperative MRI with intraoperative findings, and examine its significance on surgical resectability. This information could guide clinicians in preoperative planning and advising patients on treatment options and potential risks/benefits. MRI is very sensitive (100%) and moderately specific (67%) in detecting direct anatomical contact between conus and MPE tumors.

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Spinal cord ependymomas: a retrospective analysis of 59 cases

Cited by 126 publications

References 23 publications

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

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

A multicenter study of the prognosis and treatment of adult brain ependymal tumors

Myxopapillary ependymoma: correlation of clinical and imaging features with surgical resectability in a series with long-term follow-up

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