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

Background Spinal ependymomas are the most common intradural tumors in adults and frequently lead to progressive neurological decline due to spinal cord compression. They typically present with subacute symptoms. The 2016 WHO classification stratifies them by histological grade, with recent updates incorporating molecular features. Contrast-enhanced MRI remains the gold standard for diagnosis. Surgical resection is the mainstay of treatment, with gross total resection (GTR) linked to superior clinical and oncological outcomes. Methods We conducted a retrospective analysis of adult patients who underwent surgery for spinal ependymoma between 2010 and 2023. Demographic, clinical, radiological, and histopathological data were collected. Functional status was evaluated using the McCormick, Sourse, and modified Rankin scales. Statistical analyses included Cox proportional hazards models and Kaplan-Meier survival estimates. Results Fifty-six patients were included (mean age: 36.8 years; 54.5% male). Tumors were most commonly located in the cervical (54.5%) and thoracic (52.7%) regions. The predominant symptoms were sensory disturbances (92.7%), motor weakness (90.9%), and pain (78.2%). GTR was achieved in 63.6% of cases. Overall, 89.1% of patients experienced functional improvement, with motor recovery observed in 76.4%. Progression-free survival (PFS) at 28 months was 62.1%, significantly higher in patients with GTR (82.6%) compared to subtotal resection (41.9%). Thoracic tumor location was associated with poorer functional recovery (HR: 4.7, p = 0.022), while GTR significantly decreased recurrence risk (HR: 0.25, p = 0.028). Conclusions Spinal ependymomas predominantly affect adults in their fourth decade, with a slight male predominance. GTR significantly improves PFS and reduces the likelihood of recurrence, underscoring its therapeutic value. Thoracic location and the presence of syringomyelia are adverse prognostic factors. Optimal outcomes require an aggressive but individualized surgical strategy, tailored to tumor location and preoperative functional status.