Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The aim of this study was to investigate the surgical strategies and outcomes for spinal ependymomas of different lengths.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors used data from 210 patients with spinal ependymomas (WHO Grades II and III) in this 10-year retrospective study (January 1999 to December 2008), dividing them into 3 different groups according to length (spinal ependymomas &lt; 5 cm, 5–10 cm, and &gt; 10 cm). All patients underwent tumor resection. The basic characteristics of the patients were reviewed and the functional status was assessed using the McCormick classification.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>There were 89, 81, and 40 patients, respectively, in the 3 groups (&lt; 5 cm, 5–10 cm, and &gt; 10 cm). Grosstotal resections (GTRs) were performed in 172 patients (81.9% overall, or 86.5%, 79.0%, and 77.5% in the 3 groups, respectively). Subtotal and partial resections were achieved in 38 patients (18.1%). Eight patients with medulla oblongata or upper cervical cord tumors received a tracheotomy postoperatively. The follow-up period ranged from 56 to 176 months. One hundred thirty-five patients (76.7%) experienced improvement, (88.2%, 83.8%, and 34.4% in the &lt; 5 cm, 5–10 cm, and &gt; 10 cm groups, respectively). Thirty-three patients (18.8%) maintained their pretreatment status, and 8 patients (4.5%) showed deterioration following tumor resection at 6 months. Tumor recurrence or progression was observed in 6 (2.9%) of the 210 patients. Among the 6 patients, recurrent tumors were located in the conus (n = 3), thoracic (n = 1), and medullocervical cord (n = 2).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Radical resection of spinal ependymomas could be performed in most patients, and the rate of GTR was significantly different in the different-length groups (&lt; 10 cm vs &gt; 10 cm, p = 0.032). Patients with longer tumors had worse surgical results compared with those with small tumors (p &lt; 0.001), and more postoperative neuropathic pain and proprioceptive deficits could usually be observed in patients harboring larger tumors. Early diagnosis and timely operation are critical to achieving better neurological outcomes. For tumors with dense adhesions, complete removal should be performed cautiously because of the significant incidence of neurological deterioration.</jats:p></jats:sec>

Spinal ependymomas. Part 1: Intramedullary ependymomas

“…The multivariate analysis disclosed a number of in- 19 and operating on a de novo rather than a recurrent ependymoma were the strongest predictors for a GTR. Other independent factors favoring a GTR were absence of arachnoid adhesions between cord and dura, a short clinical history, and an experienced surgeon (Table 4).…”

“…11 In this series, 86.3% of ependymomas underwent GTR, 3,[5][6][7]10,16,19,20,[28][29][30]33 with a steady increase of this rate throughout the overall study period. The major reasons for the steadily increasing GTR rates appear to be the improvements in preoperative MRI as well as the intraoperative ultrasound visualization, the introduction of small ultrasonic aspirators, and increasing experience of neurosurgeons.…”

“…A watch-and-wait policy cannot be supported. 2,3,5,6,16,18,19,27,32 transient morbidity Further analysis showed a trend for higher rates of postoperative transient morbidity with increasing age. 7,11,31 Elderly patients demonstrated more difficulties to overcome deficits of joint position sense in particular.…”

“…16,21 The length of the myelotomy was found to correlate with postoperative sensory dysfunctions in several studies. 4,5,19,30 The only tumors which could be removed without inflicting such sensory disturbances were those that had reached the pia mater or grown out of the cord in exophytic fashion. In such cases, the tumor could be entered directly without requiring a myelotomy (Fig.…”

“…This immediate postoperative worsening involved sensory functions for almost all patients. 6,19,21,29 Postoperative sensory deficits are an inevitable consequence of the myelotomy required to reach an intramedullary tumor. 16,21 The length of the myelotomy was found to correlate with postoperative sensory dysfunctions in several studies.…”