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Intramedullary spinal cord ependymomas in children: treatment, results and follow-up
M Lonjon1, K Y Goh, F J Epstein
1Service de Neurochirurgie, Hôpital Pasteur, Nice, France. mlonjon@aol.com
Insights
Complete surgical removal of pediatric intramedullary spinal cord ependymomas offers excellent long-term survival rates. Post-operative radiation therapy is often unnecessary, supporting conservative management strategies for these pediatric tumors.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Oncology
- Spinal Cord Tumors
Background:
- Intramedullary spinal cord ependymomas are rare tumors in children.
- Optimal management strategies require understanding surgical outcomes and recurrence patterns.
Purpose of the Study:
- To evaluate surgical results, long-term follow-up, and recurrence rates in pediatric patients with intramedullary spinal cord ependymomas.
- To assess the necessity of post-operative radiation therapy.
Main Methods:
- Retrospective review of 20 pediatric patients with intramedullary spinal cord ependymomas.
- Surgical resection performed between 1985 and 1996.
- Clinical evaluation before and after surgery, and at long-term follow-up.
Main Results:
- Gross total resection achieved in 14 patients (70%); subtotal in 6 (30%).
- Median follow-up was 67 months.
- 80% of patients showed clinical improvement or stability; 90% 5- and 10-year survival rates; 93% and 70% 5- and 10-year progression-free survival rates, respectively.
- Recurrence occurred in 3 patients (15%).
Conclusions:
- Complete resection of pediatric intramedullary spinal cord ependymomas is achievable.
- High long-term survival rates support avoiding routine post-operative radiation therapy.
Abstract:
A retrospective review of 20 pediatric patients with intramedullary spinal cord ependymomas, all of whom underwent operative resection between 1985 and 1996, was undertaken to determine surgical results, long-term follow-up and tumor recurrence. Twelve children operated on in the same period with filum or cauda equina ependymomas were not included in this study. Nine children had had previous treatment before referral. Gross total resection was achieved in 14 patients and subtotal in 6. None of these had a post-operative radiation therapy. The median follow-up period was 67 months (range 25-177 months). All children were clinically evaluated before and after operation and at the last follow-up. The clinical grade at the last follow-up showed improvement in 8 patients (40%), was unchanged in 10 (50%) and deteriorated in 2 (10%). Three patients had a recurrence, 2 at the primary site (2 and 3 years after our surgery) and 1 at a distant site (3 years after). The actuarial 5- and 10-year survival rates were both 90%; 5- and 10-year progression-free survival rates were 93 and 70%, respectively. We conclude that a complete removal can be achieved in almost all cases of intramedullary spinal cord ependymomas in children, and that the long survival rates justify avoiding post-operative radiation therapy.
