open access

Vol 51, No 6 (2017)
Original research articles
Submitted: 2016-11-11
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Surgical treatment of intramedullary ependymomas

Marek Prokopienko, Przemysław Kunert, Anna Podgórska, Andrzej Marchel
DOI: 10.1016/j.pjnns.2017.06.008
·
Neurol Neurochir Pol 2017;51(6):439-445.

open access

Vol 51, No 6 (2017)
Original research articles
Submitted: 2016-11-11

Abstract

Object

The aims of this study were to present the results of surgery for intramedullary ependymomas (IEs), analyze complication and recurrence rates, and analyze factors that might influence outcome.

Methods

The charts of 29 consecutive patients (women – 8, men – 21; mean age – 38 years; range: 18–72) operated for IE were retrospectively analyzed. Mean follow-up was 9 years. Eighteen tumors (62%) were located in the cervical or cervicothoracic spine, and average tumor length was four spinal levels. Twenty patients (69%) presented with neurological deficit.

Results

Gross total resections (GTRs) comprised 87% of cases, subtotal resections (STRs) 10%, and partial resections 3%. The neurological outcome on postoperative day 1 was as follows: modified McCormick scale (mMS) grade I – 6%, grade II – 21%, grade III – 21%, grade IV – 31%, and grade V – 21%; at follow-up, outcomes were mMS grade I – 42%, grade II – 34%, grade III – 10%, and grade V – 14% of patients. Compared to the preoperative period, 69% of patients deteriorated postoperatively; however, 62% improved or remained without deficit in follow-up, and deterioration persisted in 24%. The functional results were significantly worse when the intraoperative monitoring potentials dropped below 50% (p=0.005) and if the tumor involved >3 spinal levels (p=0.039). Fourteen postoperative complications in 10 patients (34%) included respiratory failure (14%), pneumonia (7%), urinary infection (10%), bed sores (10%), and CSF leak (7%). Two tumors progressed after STR, with progression-free survival times of 5 and 14 years. No recurrence was observed after GTR.

Conclusions

Total tumor resection is the treatment of choice in cases of IEs: no tumor re-growth occurred after total resection, 86% of patients were independent at follow-up, and the 10-year survival rate was 79%.

Abstract

Object

The aims of this study were to present the results of surgery for intramedullary ependymomas (IEs), analyze complication and recurrence rates, and analyze factors that might influence outcome.

Methods

The charts of 29 consecutive patients (women – 8, men – 21; mean age – 38 years; range: 18–72) operated for IE were retrospectively analyzed. Mean follow-up was 9 years. Eighteen tumors (62%) were located in the cervical or cervicothoracic spine, and average tumor length was four spinal levels. Twenty patients (69%) presented with neurological deficit.

Results

Gross total resections (GTRs) comprised 87% of cases, subtotal resections (STRs) 10%, and partial resections 3%. The neurological outcome on postoperative day 1 was as follows: modified McCormick scale (mMS) grade I – 6%, grade II – 21%, grade III – 21%, grade IV – 31%, and grade V – 21%; at follow-up, outcomes were mMS grade I – 42%, grade II – 34%, grade III – 10%, and grade V – 14% of patients. Compared to the preoperative period, 69% of patients deteriorated postoperatively; however, 62% improved or remained without deficit in follow-up, and deterioration persisted in 24%. The functional results were significantly worse when the intraoperative monitoring potentials dropped below 50% (p=0.005) and if the tumor involved >3 spinal levels (p=0.039). Fourteen postoperative complications in 10 patients (34%) included respiratory failure (14%), pneumonia (7%), urinary infection (10%), bed sores (10%), and CSF leak (7%). Two tumors progressed after STR, with progression-free survival times of 5 and 14 years. No recurrence was observed after GTR.

Conclusions

Total tumor resection is the treatment of choice in cases of IEs: no tumor re-growth occurred after total resection, 86% of patients were independent at follow-up, and the 10-year survival rate was 79%.

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Keywords

CNS, IOM, DTI, SEPs, MEPs, TES, GTR, STR, mMS

About this article
Title

Surgical treatment of intramedullary ependymomas

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 51, No 6 (2017)

Pages

439-445

DOI

10.1016/j.pjnns.2017.06.008

Bibliographic record

Neurol Neurochir Pol 2017;51(6):439-445.

Keywords

CNS
IOM
DTI
SEPs
MEPs
TES
GTR
STR
mMS

Authors

Marek Prokopienko
Przemysław Kunert
Anna Podgórska
Andrzej Marchel

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