Current Approach and Predictors of Clinical Outcomes in Adults With Spinal Ependymomas

Area of Science:

• Neurosurgery
• Oncology
• Neurology

Background:

• Spinal ependymomas are common intradural tumors in adults causing neurological decline.
• Diagnosis relies on contrast-enhanced MRI, with classification evolving to include molecular features.
• Surgical resection is the primary treatment, with gross total resection (GTR) offering better outcomes.

Purpose of the Study:

• To analyze outcomes of surgical resection for spinal ependymomas.
• To identify prognostic factors influencing functional recovery and recurrence.
• To evaluate the impact of gross total resection (GTR) on patient prognosis.

Main Methods:

• Retrospective analysis of 56 adult patients undergoing surgery for spinal ependymoma (2010-2023).
• Data collected included demographics, clinical presentation, radiological findings, and histopathology.
• Functional status assessed using McCormick, Sourse, and modified Rankin scales; survival analyzed with Cox models and Kaplan-Meier estimates.

Main Results:

• Most common symptoms include sensory disturbances (92.7%), motor weakness (90.9%), and pain (78.2%).
• Gross total resection (GTR) achieved in 63.6%, leading to functional improvement in 89.1% and motor recovery in 76.4%.
• Progression-free survival (PFS) at 28 months was 62.1%, significantly higher with GTR (82.6%) vs. subtotal resection (41.9%). Thoracic location predicted poorer recovery (HR: 4.7, p=0.022); GTR reduced recurrence (HR: 0.25, p=0.028).

Conclusions:

• Spinal ependymomas primarily affect adults in their fourth decade, with a male predominance.
• Gross total resection (GTR) is crucial for improving PFS and minimizing recurrence risk.
• Thoracic location and syringomyelia are adverse prognostic factors; individualized surgical strategies are essential for optimal outcomes.