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Spinal ependymal tumors
Manfred Westphal1, Malte Mohme1
1Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
Abstract:
Spinal ependymomas are strictly to be subdivided into intramedullary lesions and extramedullary lesions as they are histologically and genetically distinct. Whereas the intramedullary lesions (SPE) are assigned to the WHO grade 2 and very rarely grade 3, the extramedullary lesions or myxopapilary tumors (MPE) are only as recently also assigned to WHO grade 2. The major difference is that in general, an intramedullary lesion of grade 2 remains confined to the local site of origin, even when rarely recurring after complete resection. In contrast, the MPEs have the capacity to spread throughout the cerebrospinal fluid compartment but can also be controlled by cautious complete resection. We here review the clinical features of spinal ependymomas, contrasting the entities, and describe the treatment found best from the literature to manage these lesions including interdisciplinary approaches.
Insights
Spinal ependymomas (SPE) and myxopapillary tumors (MPE) are distinct spinal tumor types. This review contrasts their clinical features and management, highlighting differences in behavior and treatment strategies.
Area of Science:
- Neuro-oncology
- Spinal cord pathology
- Tumor classification
Background:
- Spinal ependymomas are classified into intramedullary (SPE) and extramedullary (MPE) types, exhibiting distinct histological and genetic profiles.
- SPEs are typically WHO grade 2 or 3, while MPEs are now also classified as WHO grade 2.
- SPEs are generally localized, whereas MPEs can disseminate within the cerebrospinal fluid (CSF) compartment.
Purpose of the Study:
- To review and contrast the clinical features of spinal ependymomas (SPE) and myxopapillary tumors (MPE).
- To describe optimal management strategies for these distinct spinal tumor entities.
- To emphasize interdisciplinary approaches in treating spinal ependymomas.
Main Methods:
- Literature review of clinical features of spinal ependymomas.
- Comparative analysis of intramedullary (SPE) and extramedullary (MPE) lesions.
- Synthesis of treatment recommendations from existing literature.
Main Results:
- SPEs (WHO grade 2/3) are typically locally confined, with rare recurrence after resection.
- MPEs (WHO grade 2) demonstrate potential for CSF dissemination but can be managed with careful resection.
- Distinct clinical behaviors necessitate tailored management approaches for SPE and MPE.
Conclusions:
- Accurate differentiation between SPE and MPE is crucial for effective treatment planning.
- Interdisciplinary collaboration is essential for optimizing outcomes in spinal ependymoma management.
- Understanding the unique characteristics of SPE and MPE guides therapeutic strategies and prognosis.
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