title: Intramedullary spinal ependymomas: analysis of a consecutive series of 82 adult cases with particular attention to patients with no preoperative neurological deficit.
abstract: OBJECTIVE
  Surgery should be considered for patients with intramedullary spinal ependymomas (ISE), particularly those presenting with a neurological deficit preoperatively. In contrast, it is still a debatable matter whether to recommend the same approach for patients with no neurological impairment. To investigate this matter, we analyzed the data of 82 consecutive patients with ISEs treated at our institution.
  
  
  METHODS
  We reviewed the medical charts of all ISE patients undergoing operation at our institution between 1985 and 2000. Particular attention was given to patients without neurological deficit before surgery.
  
  
  RESULTS
  Eighty-two consecutive ISE patients were included in this study. Preoperatively, a neurological deficit of variable severity was present in 72 patients (Group A, 88%) and absent in 10 patients (Group B, 12%). In the latter group, seven patients had progressive and nonspecific pain as the only presenting symptom; two had arm dysesthesias; and in one patient, ISE was diagnosed incidentally. The mean duration of their symptoms was 21 months. We achieved a total tumor excision in nine patients and subtotal removal in one. At the last follow-up assessment (mean, 45 mo), all Group B patients remained at Grade I of the McCormick classification, except one, who deteriorated to Grade Ib. Furthermore, nonspecific pain diminished in three patients, stabilized in four, and worsened in one. Arm dysesthesias diminished in one patient and stabilized in the other. No surgery-related complication or recurrence was recorded in these patients.
  
  
  CONCLUSIONS
  Surgery should be carefully considered for ISE patients with no objective neurological deficit preoperatively because, in our experience, it resolves their preoperative complaints in 30% of cases, stabilizes them in 60%, and worsens them in 10%.
authors.affiliation: Department of Neurosurgery, Bicêtre University Hospital, Bicêtre, France. Nozar.aghakhani@bct.aphp.fr
authors.forename: Nozar
authors.initials: N
authors.lastname: Aghakhani
authors.forename: Philippe
authors.initials: P
authors.lastname: David
authors.forename: Fabrice
authors.initials: F
authors.lastname: Parker
authors.forename: Catherine
authors.initials: C
authors.lastname: Lacroix
authors.forename: Farida
authors.initials: F
authors.lastname: Benoudiba
authors.forename: Marc
authors.initials: M
authors.lastname: Tadie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D015331:Cohort Studies; D004806:Ependymoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D010292:Paresthesia / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome