Surgical outcome and prognostic factors of spinal intramedullary ependymomas in adults

The goal of treatment for spinal ependymoma is complete removal with minimal postoperative neurological deficit. The authors correlated the results of surgical management for spinal cord ependymoma with the rate of postoperative disease progression and the prognostic factors. Thirty-one cases of spinal ependymomas, surgically treated between 1979 and 1998, were retrospectively analyzed. The authors reviewed clinical features, radiological characteristics and operative findings for the surgical outcome analysis. Thirty-five percent of patients with preoperative Nurick's grade better than grade 4 showed improvement in functional status, whereas no improvement was observed in patients with preoperatively poorer functional status (P = 0.05). The proportion of complete surgical removals was influenced by tumor location (40% in cases around the conus versus 97% in other regions, P = 0.003) and histology (42% in the myxopapillary subtype versus 97% in the non-myxopapillary subtype, P = 0.001). Disease progression was observed in six cases, the mean progression free interval after surgical removal was 83 months and the 5-year progression free rate was 70%. Disease progression was found in two out of 23 cases from the complete removal group and in four out of eight cases from the incomplete removal group (P = 0.008). In the aspect of disease progression, the only statistically significant factor by multivariate analysis was the surgical extent of removal (P = 0.010). Of those patients where there was incomplete removal, radiation therapy lead to improved clinical results, which were not statistically significant (P = 0.27). In the surgical treatment of spinal cord ependymoma, preoperative functional status and the extent of removal were the significant prognostic factors influencing postoperative outcome. Early diagnosis is vital and complete removal of the tumor should be attempted in all surgical treatment of spinal ependymoma.