Outcomes in spinal ependymoma: A retrospective analysis of 38 patients

Spinal ependymomas are rare central nervous system tumors with an incidence of approximately 1 in 100,000. They comprise 2-6% of CNS tumors, and up to 60% of intramedullary tumors. In this study, we retrospectively analyzed prognostic factors affecting progression-free survival (PFS) and postoperative outcomes for 38 patients.

Clinical and histological data were collected for 38 patients treated at a single neurosurgical center (2012-2021). Data included presenting symptoms, tumor grade and location, type of management (gross total resection [GTR], subtotal resection [STR], or conservative), use of adjuvant therapy, and outcomes such as PFS and functional status.

Patients averaged 55 years of age, and there was an equal gender distribution. Tumors most commonly occurred in the lumbar spine (58%), and 47% were classified as the World Health Organization Grade II. Pain was the most frequent presenting symptom (79%). GTR was achieved in 58% of patients, STR in 36%, and 13% were managed conservatively. GTR significantly reduced tumor progression compared to STR (P = 0.008); no progression was observed in the GTR group. Functional outcomes were better with GTR; 58% of patients showed improvement postoperatively versus 50% in the STR group. Adjuvant therapy was utilized in 18% of cases and showed no significant impact on PFS or functional outcomes (P > 0.99). The overall 5-year PFS rate was 75%.

This study underscores the importance of GTR in reducing progression while preserving functional outcomes in spinal ependymoma. Adjuvant therapy remains controversial, with limited evidence supporting its benefit.