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Surgical treatment of rare cauda equina tumours

Acta Neurochirurgica volume 153, Article number: 1787 (2011) Cite this article

Abstract

Background

Cauda equina tumours (CET) are rare and usually benign. Treatment of schwannomas and benign ependymomas, which are the most frequent histopathological types of CET, is now well established. However, management of other presumed histopathological types of CET is still a matter of debate. The aim of this study was to assess the incidence and the surgical treatment of rare CET.

Method

A retrospective study was carried out on 176 adult patients surgically treated for CET in our two departments from 1994 to 2010. We reviewed pre- and postoperative symptoms, magnetic resonance imaging aspects, surgical findings, outcome including operative neurological morbidity, local recurrence rate and operative mortality, and incidence of rare CET.

Findings

Seventeen percent (30 patients) of CETs operated on were neither schwannomas nor benign ependymomas. Half of these cases were benign tumours, with paragangliomas being the most common. Two patients were in poorer clinical condition after surgery, one patient experienced a local recurrence, and one died following surgery, from the progress of his disease (Von Hippel-Lindau disease). The other half were malignant tumours, with metastases being the most common. One third of the patients were worsened by surgery, and the mortality rate was 1/3 at 8 months (1–27 months).

Conclusions

Roughly one in six CET were neither schwannomas nor benign ependymomas. This study demonstrated the efficiency of surgery for rare benign CET with a low local recurrence rate. Surgical treatment of rare malignant CET led to a high rate of increased postoperative neurological deficit in patients with a reduced life expectancy.

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Conflicts of interest

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Affiliations

  1. Department of Neurosurgery, Pontchaillou University Hospital, 2, rue Henri le Guilloux, 35033, Rennes Cedex 9, France

    Pierre-Louis Hénaux, Laurent Riffaud, Abderrahmane Hamlat, Gilles Brassier & Xavier Morandi

  2. Department of Neurosurgery, Bretonneau University Hospital, Boulevard Tonnellé, 37000, Tours Cedex, France

    Ilyess Zemmoura & Patrick François

Authors
  1. Pierre-Louis Hénaux
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  2. Ilyess Zemmoura
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  3. Laurent Riffaud
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  4. Patrick François
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  5. Abderrahmane Hamlat
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  6. Gilles Brassier
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  7. Xavier Morandi
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Correspondence to Pierre-Louis Hénaux.

Additional information

Comment

The authors present a case series of non-schwannoma non-ependymoma cauda equina tumors from two centers over a 16-year period. The paper does not provide any truly novel information, but does confirm and provide supporting information regarding the relative frequency of these tumors appearing in the region of the cauda equina. It should be noted that the identity of many of the unusual tumors may have been predicted preoperatively, such as the patient with VHL or the patients with known metastatic disease. The authors emphasize the need for a broad differential diagnosis and for a tissue diagnosis when confronted with tumors in the lumbar cistern.

Daniel Resnick

Madison, WI

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Hénaux, PL., Zemmoura, I., Riffaud, L. et al. Surgical treatment of rare cauda equina tumours. Acta Neurochir 153, 1787 (2011). https://doi.org/10.1007/s00701-011-1094-2

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  • DOI: https://doi.org/10.1007/s00701-011-1094-2

Keywords

  • Cauda equina
  • Rare tumours
  • Intradural extramedullary
  • Paragangliomas
  • Spinal metastases