Surgical Treatment of Spinal Ependymomas: Experience in 49 Patients.

Surgical Treatment of Spinal Ependymomas: Experience in 49 Patients.

World Neurosurg. 2018 Jan 05;:

Authors: Wild F, Hartmann C, Heissler HE, Hong B, Krauss JK, Nakamura M

Abstract
BACKGROUND: Ependymomas are rare tumors of the central nervous system. The local tumor distribution in the central nervous system is highly age-dependent as among adults ependymomas occur mostly in the spinal cord, whereas among children intracranial manifestations are more common. To date, there are no prospective studies about treatment strategies for ependymomas. In most cases complete tumor resection is recommended. The role of radiation therapy in low-grade ependymomas remains unclear.
METHODS: We report the results of 49 patients, treated in the Department of Neurosurgery at Hannover Medical School over an 18-year-period. Patients' clinical and radiological data were analyzed retrospectively.
RESULTS: At the time of surgery the mean age of patients was 46.4 years. There were 29 women (59%), and 20 men (41%). Gross total resection (GTR) was achieved in 72% of patients. Tumors affected the cervical spinal cord in 14 patients (29%), cauda equine/filum terminale in 10 (21%), conus medullaris in 8 (16%), the thoracic spinal cord in 7 ( 14%), and the cervico- or thoracolumbar junction in 10 (20%). Postoperative radiation therapy was performed in 6 cases. Long-term follow-up was available for 39 patients of a mean of 50.7 months. The higher the preoperative McCormick grade, the higher was the risk for clinical deterioration postoperatively. On long-term follow-up the clinical status was the same then preoperatively in 51% of patients, worse in 21%, and improved in 28%. Considering progression free survival (PFS) we found no differences with regard to histology. There were 4 tumor relapses after progression-free survival of a mean of 21 months.
CONCLUSIONS: GTR is considered to be the first choice in the treatment of spinal ependymomas. The most important predictor of clinical outcome is preoperative neurological functioning. The role of postoperative radiation needs further clarification.

PMID: 29309981 [PubMed - as supplied by publisher]

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