Spinal cord ependymoma: radical surgical resection and outcome.
OBJECTIVE
Several authors have noted increased neurological deficits and worsening dysesthesia in the postoperative period in patients with spinal cord ependymoma. We describe the neurological progression and pain evolution of these patients over the 1-year period after surgery. In addition, our favored method of en bloc tumor resection is illustrated, and the rate of complications, recurrence, and survival in this group of patients is addressed.


METHODS
We operated on 26 patients (12 male and 14 female) with low-grade spinal cord ependymomas between 1975 and 2001. The median age at diagnosis was 42 years. Tumors extended into the cervical cord in 13 patients, the thoracic cord in 7 patients, and the conus medullaris in 6 patients. Eleven patients had previous surgery and/or radiation therapy.


RESULTS
We achieved a gross total resection in 88% of patients, whereas 8% had a subtotal resection and 4% had a biopsy. Only 1 patient developed a recurrence over a mean follow-up period of 31 months.


CONCLUSIONS
We conclude that radical surgical resection of spinal cord ependymomas can be safely achieved in the majority of patients. A trend toward neurological improvement from a postoperative deficit can be expected between 1 and 3 months after surgery and continues up to 1 year. Postoperative dysesthesias begin to improve within 1 month of surgery and are significantly better by 1 year after surgery. The best predictor of outcome is the preoperative neurological status.
Hanbali
Fadi
F
Department of Neurosurgery, University of Texas Medical Branch at Galveston, Galveston, TX, USA.
Fourney
Daryl R
DR
Marmor
Eric
E
Suki
Dima
D
Rhines
Laurence D
LD
Weinberg
Jeffrey S
JS
McCutcheon
Ian E
IE
Suk
Ian
I
Gokaslan
Ziya L
ZL
D000293:Adolescent; D000328:Adult; D000368:Aged; D004806:Ependymoma / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D012678:Sensation Disorders / Q000209:etiology; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome