Surgical Treatment of Spinal Ependymomas: Experience in 49 Patients

Ependymomas are rare central nervous system tumors. Local tumor distribution in the central nervous system depends on age: 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 is unclear.

We report the results of 49 patients over an 18-year-period. Patients' clinical and radiologic data were analyzed retrospectively.

Mean age of patients at time of surgery was 46.4 years. There were 29 women (59%) and 20 men (41%). Gross total resection was achieved in 72% of patients. Tumors affected cervical spinal cord in 14 patients (29%), cauda equina and filum terminale in 10 (21%), conus medullaris in 8 (16%), thoracic spinal cord in 7 (14%), and cervicolumbar or thoracolumbar junction in 10 (20%). Postoperative radiation therapy was performed in 6 cases. Long-term follow-up was available for 39 patients (mean 50.7 months). High preoperative McCormick grade correlated with high risk for clinical deterioration postoperatively. On long-term follow-up, clinical status was the same as preoperatively in 51% of patients, worse in 21%, and improved in 28%. We found no differences in progression-free survival with regard to histology. Four tumors relapsed after progression-free survival of a mean of 21 months.

Gross total resection is considered the first choice in treatment of spinal ependymomas. The most important predictor of clinical outcome is preoperative neurologic functioning. The role of postoperative radiation needs further clarification.