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Clinical features and long-term outcomes of intraspinal ependymomas in pediatric patients
Tao Yang1, Liang Wu, Chenlong Yang
1Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China, yangtaoczh@163.com.
Insights
Pediatric intraspinal ependymomas (WHO grade II) are best treated with gross total resection (GTR) for favorable outcomes. Subtotal resection (STR) may require further intervention and careful consideration of radiotherapy.
Area of Science:
- Neuro-oncology
- Pediatric Neurosurgery
- Spinal Cord Tumors
Background:
- Intraspinal ependymomas (WHO grade II) are a significant cause of morbidity in pediatric patients.
- Understanding the clinical course and treatment outcomes is crucial for improving patient care.
Purpose of the Study:
- To analyze the clinical features, radiological findings, surgical management, and long-term results of pediatric intraspinal ependymomas (WHO grade II).
- To evaluate the efficacy of gross total resection (GTR) versus subtotal resection (STR) in managing these tumors.
Main Methods:
- Retrospective review of 15 pediatric patients who underwent microsurgery for intraspinal grade II ependymomas.
- Pre- and postoperative MRI for all patients; diagnosis confirmed by pathology.
- Follow-up data collected through office visits.
Main Results:
- The cohort included 10 males and 5 females with a mean age of 13.7 years.
- Tumor locations varied across the spinal cord; motor deficits were the most common symptom.
- Gross total resection (GTR) was achieved in 12 patients, with favorable neurological outcomes in 12, and stable status in 3.
- Two subtotal resection (STR) cases showed tumor regrowth, necessitating re-operation in one.
Conclusions:
- Pediatric intraspinal ependymomas (WHO grade II) are surgically treatable, with GTR yielding the best outcomes.
- Early surgical intervention is recommended to prevent neurological deterioration.
- Postoperative radiotherapy for STR cases requires careful consideration due to potential toxicity and uncertain efficacy.
Purpose:
The aim of this study was to discuss the clinical manifestations, radiological features, treatment, and long-term outcomes of intraspinal ependymomas (Word Health Organization grade II) in pediatric patients.
Methods:
The data of 15 pediatric patients who underwent microsurgery for intraspinal grade II ependymomas were retrospectively reviewed. Pre- and postoperative magnetic resonance imaging was performed in all patients. The diagnosis of grade II ependymomas was based on pathology. All the follow-up data were obtained during office visits.
Results:
There were ten males and five females, with a mean age of 13.7 ± 3.4 years. Four tumors were located in the cervical cord, six in the cervicothoracic cord, four in the thoracic cord, and one in the conus-cauda region, respectively. The most common symptom was motor deficits. Gross total resection (GTR) of the tumor was achieved in 12 cases, and subtotal resection (STR) was achieved in three cases. Regrowth of the residual tumor was observed in two STR cases during a mean follow-up period of 44.8 months. STR was performed again in one case due to clinical progression. At the last follow-up, 12 patients experienced an improvement in the neurological function and three patients maintained their preoperative status.
Conclusions:
Pediatric intraspinal grade II ependymomas are amenable to surgical resection before neurological deficits deteriorate. GTR is the best treatment of choice, and the outcome is favorable. Due to uncertain therapeutic efficacy and possible radiation-induced toxicity, postoperative radiotherapy should be considered carefully for cases of STR.
