Intramedullary medullocervical ependymoma--surgical treatment, functional recovery, and long-term outcome.
To evaluate the long-term outcome and functional recovery of intramedullary medullocervical ependymoma (IME), the clinical charts of 38 surgically treated consecutive cases of IME were reviewed. Follow-up was obtained prospectively. The mean age of the patients (19 male and 19 female) was 35.3 years (range: 11-60 years). Complete resection was achieved in 33 (86.8%) patients. Fourteen patients worsened postoperatively; five and seven of these improved to their baseline levels within 1 and 3 months, respectively. By 1 year postoperatively, 17 patients returned to work. After a mean follow-up duration of 81.5 months, 31 patients improved or stabilized, and 3 had recurrence. The means of the modified McCormick grade (mMG) scores before the operation, at discharge, 1 year after the operation, and at the most recent evaluation were 1.76, 2.13, 1.82, and 1.84, respectively. A favorable long-term outcome of the mMG was associated with a good preoperative status (mMG I) (odds ratio [OR] = 9.956, p = 0.008) and well-defined tumor boundary (OR = 7.829, p = 0.035). Improvements in the postoperative walking dysfunction and paresthesia over time were associated with the absence of preoperative walking dysfunction (p = 0.047) and paresthesia (p = 0.028), respectively. The 12-year progression/recurrence-free survival and overall survival rates were 92.0% and 93.7%, respectively. The study suggests that the goal of surgery is to stabilize the preoperative neurological function and that a favorable outcome may be achieved in patients with good preoperative statuses and well-defined tumor boundaries. Surgery should be performed as soon as possible after the diagnoses and before the neurological functions deteriorate.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University.
Da
D
Li
Shu-Yu
SY
Hao
Zhen
Z
Wu
Gui-Jun
GJ
Jia
Li-Wei
LW
Zhang
Jun-Ting
JT
Zhang
D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae; D002648:Child; D003399:Craniotomy / Q000379:methods; D018572:Disease-Free Survival; D004806:Ependymoma / Q000534:rehabilitation / Q000601:surgery*; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015192:Infratentorial Neoplasms / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000601:surgery*; D008875:Middle Aged; D051346:Mobility Limitation; D016343:Monitoring, Intraoperative; D009069:Movement Disorders / Q000209:etiology; D010292:Paresthesia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013120:Spinal Cord Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult