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Intramedullary ependymoma: long-term outcome after surgery

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Abstract

Background

Overall (OS) and progression-free survival (PFS) of patients undergoing spinal ependymoma resection has been frequently reported. Contrarily, OS and PFS of purely intramedullary ependymomas have not been clearly determined yet.

Methods

The data of 37 patients undergoing resection of an intramedullary ependymoma (IE) from January 2000 to December 2016 were analysed retrospectively.

Results

The mean age was 46 years. The male:female ratio was 24:13. The median duration of symptoms was 12 months. Sixty-two per cent of ependymomas were in the cervical, 24% in the thoracic, and 14% in the conus region in our series. The median volume was 1.3 ml. A syrinx was found in 49% and a cyst in 32%. GTR was achieved in 89%, STR in three (8%), and PR in one patient (3%). Median follow-up was 114 months. PFS was 87%, 82%, and 82% at 5, 10, and 15 years, respectively. OS was 97%, 88%, and 63% at 5, 10, and 15 years, respectively. There was a significant difference in PFS depending on the extent of resection and in OS depending on the pre-operative clinical status. There was no significant difference in OS and PFS regarding the other examined influencing factors.

Conclusion

GTR resection was the most important factor influencing PFS. According to our results OS of IEs is much worse than that of spinal ependymomas. Our analysis confirms that patients with good pre-operative (McCormick grade 1 and 2) clinical status have significantly better OS than patients with McCormick grade 3 and higher.

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Authors and Affiliations

  1. Department of Neurosurgery and Neurooncology, Military University Hospital and Charles University, First Medical Faculty, U Vojenské nemocnice 1200/1, 162 00, Prague 6, Czech Republic

    N. Svoboda, O. Bradac, P. de Lacy & V. Benes

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  1. N. Svoboda
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  2. O. Bradac
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  3. P. de Lacy
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  4. V. Benes
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Correspondence to N. Svoboda.

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Appendix

Appendix

Case of a 19-year-old male with intramedullary ependymoma at the C4–C7 level, with a 9-month history of dysaesthesia. (a) Pre-operative sagittal MR T2-weighted image displays well-defined tumour. (b–e) Intra-operative images showing the course of resection. (b) Blunt separation until exposure of posterior wall of IE is achieved. (c) The tumour is dissected along its borders. (d) Careful separation of the anterior part of the IE. (e) The tumour is en block resected, achieving GTR. (f) Post-operative sagittal MR T2-weighted image shows no remnant of the tumour 3 months after the removal.

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Svoboda, N., Bradac, O., de Lacy, P. et al. Intramedullary ependymoma: long-term outcome after surgery. Acta Neurochir 160, 439–447 (2018). https://doi.org/10.1007/s00701-017-3430-7

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