Spinal myxopapillary ependymoma: neurological deterioration in patients treated with surgery.
METHODS
A retrospective multicenter study of series of 20 patients with myxopapillary ependymomas, which underwent surgery. OBJECTIVE.: To evaluate the postoperative outcomes of patients surgically treated for spinal myxopapillary ependymoma. Neurologic deterioration after tumor resection is discussed in terms of the tumor encapsulation. SUMMARY OF BACKGROUND DATA.: Myxopapillary ependymomas occur most commonly in the cauda equina and/or conus medullaris region. Most series published in the literature have covered postoperative tumor recurrence and role of adjuvant radiotherapy. Few contradistinctive studies in postoperative neurological deficit were reviewed from the standpoints of MRI and histopathologic findings.


METHODS
A total of 20 patients were recruited and charts, MRI, intraoperative findings, and pathologic findings were reviewed. The follow-up period ranged from 2 to 12 years (median, 72.9 months). The surgical procedures were defined as gross total removal, piecemeal total removal, and subtotal removal. Postoperative radiotherapy was given in 3 patients in whom removal had been subtotal.


RESULTS
Gross total removal was achieved in 14 patients, piecemeal gross total and subtotal removal in 3 patients each. Neurologic deterioration after surgery was seen in 5 patients, all of which were unencapsulated tumors consisting of piecemeal gross total removal in 2 patients and subtotal removal in 3 patients. Recovery of postoperative bladder dysfunction remained unchanged in 2 patients. There were no tumor recurrence and progression of the remaining tumors. Unencapsulated tumors were more frequently seen in heterogeneously enhanced tumors on MRI than in homogenously enhanced tumors with significant difference.


CONCLUSIONS
In the unencapsulated ependymomas, tumor separation and manipulation of the surrounding neural tissue caused neurologic injury. The heterogeneously enhanced ependymoma not only should be evaluated and treated meticulously, but also surgeons should not stick to total removal in infiltrated and adhering tumors as subtotally resected tumors with postoperative radiotherapy have not always recurred.
Sakai
Yoshihito
Y
Department of Orthopaedic Surgery, Nagoya University School of Medicine, Nogoya, Japan. jsakai@med.nagoya-u.ac.jp
Matsuyama
Yukihiro
Y
Katayama
Yoshito
Y
Imagama
Shiro
S
Ito
Zenya
Z
Wakao
Norimitsu
N
Kanemura
Tokumi
T
Yoshida
Go
G
Sato
Koji
K
Ando
Tomohiro
T
Nakamura
Hiroshi
H
Kato
Fumihiko
F
Yukawa
Yasutsugu
Y
Ito
Keigo
K
Ishiguro
Naoki
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D018450:Disease Progression; D004806:Ependymoma / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D011128:Polyradiculopathy / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery*; D013117:Spinal Cord Compression / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control