Evaluation of pediatric spinal ependymomas: A 25-year retrospective observational study

This study aims to evaluate the clinical and radiological features, histopathological characteristics, treatment modalities, and their effectiveness, as well as long-term follow-up results of pediatric spinal ependymomas treated at a single institution. In this retrospective study, medical records of 14 pediatric patients (3 females and 11 males) who were surgically treated for spinal ependymoma in our institution between 1995 and 2020 were reviewed. Data regarding age, gender, presenting symptoms and signs, radiological findings, postoperative status, extent of resection, histopathological grading, recurrence, tumor growth, seeding, and adjuvant treatment were collected and analyzed. Six patients had myxopapillary ependymoma, 7 patients had grade II ependymoma, and 1 had grade III ependymoma. Median age at diagnosis was 10.5 (range, 1-15) years. The most common presenting symptoms and signs were axial and radicular pain, paresis, and first motor neuron involvement. In 10 patients, gross total tumor resection was achieved. Five patients underwent additional surgeries for disease progression (recurrence or residual tumor growth). Most of the patients who had no disease progression were treated with gross total resection. Two patients experienced seeding. One patient who had a grade III tumor and did not achieve gross total resection died during follow-up. Pediatric spinal ependymomas are uncommon tumors with relatively benign course. Gross total resection should be the primary goal of surgery since it may prevent disease progression, and in case it fails, progression occurs later than those that were treated with subtotal resection.