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Published on: July 5, 2021
Outcomes of initially chosen non-operative management for spinal ependymoma
Guang-Hao Zheng1, Yao-Wu Zhang1, Kai Ji1
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Purpose:
With advancements in imaging, spinal ependymomas are increasingly detected early, often in asymptomatic or mildly symptomatic patients. This study evaluates the clinical and radiological outcomes in patients who initially underwent conservative management but subsequently underwent surgery due to disease progression.
Methods:
A retrospective analysis of 315 patients diagnosed between 2018 and 2023 identified 10 meeting the inclusion criteria (mean age: 51 years, range: 37-63). Three were asymptomatic, and seven had mild symptoms such as pain or numbness. The mean maximum tumor diameter on sagittal MRI was 23.5 mm. Tumor progression and symptom changes were monitored, with surgery performed as needed.
Results:
Over a median conservative period of 36 months, all patients eventually required surgery due to symptom progression or tumor growth, with an average tumor size increase of 22 %. Gross total resection was achieved in 80 % of cases under electrophysiological monitoring. After a median follow-up of 31.5 months, 70 % of patients maintained their preoperative modified McCormick scores, while 30 % showed deterioration.
Conclusion:
Conservative management provides a temporary option, but tumor progression is inevitable. Delayed surgery may risk worse outcomes, making timely intervention advisable for patients with tumor growth, syrinx formation, or worsening neurological symptoms.
