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Clinical Characteristics, Management, and Outcomes of Intramedullary Spinal Cord Ependymomas: A Systematic Review and
Yuris Wira Artha1,2, Lukas Widhiyanto1,2, Primadenny Ariesa Airlangga1,2
1Department of Orthopedics and Traumatology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Introduction:
Intramedullary spinal cord tumors (IMSCTs) are rare tumors, with ependymoma being the most common type. Surgical resection is the main treatment, but gross total resection (GTR) carries a risk of morbidity, while subtotal resection (STR) increases the risk of recurrence. The role of adjuvant radiotherapy is debated, and chemotherapy is rarely used except for recurrence. This study aims to investigate and compare the clinical characteristics, management, and outcomes of intramedullary spinal cord ependymomas (ISCEs) comprehensively.
Methods:
This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, analyzing clinical characteristics, management, and outcomes of ISCEs. Studies were screened using Population, Intervention, Comparison, Outcome, and Study design criteria, quality-assessed with Newcastle-Ottawa Scale and Risk Of Bias In Non-randomized Studies Of Interventions, and statistically analyzed with Review Manager 5.4.1 and R software, evaluating treatment efficacy and prognostic factors.
Results:
GTR improves neurological function, reduces recurrence, and improves survival in IMSCTs, while STR increases the risk of recurrence, which often requires radiotherapy. The meta-analysis indicates that patients who received optimal management strategies had significantly better neurological outcomes (odds ratio: 4.65; 95% confidence interval: 1.77-12.23; p=0.0018). Meta-analysis also showed that based on the management approach, the rate of complication, improvement, recurrence, and overall survival was 16%, 71%, 7%, and 18%, respectively.
Conclusions:
Surgical strategies, individualized treatment, and advanced monitoring optimize IMSCT outcomes. Future research should standardize protocols, conduct large-scale studies, and refine adjuvant therapies to improve prognosis and quality of life.
