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Impact of tumor-associated syrinx on outcomes following resection of primary ependymomas of the spinal cord

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Abstract

Purpose

To interrogate the association of tumor-associated syrinxes with postoperative neurological and oncological outcomes in patients surgically treated for WHO grade 2 spinal ependymomas.

Methods

Adults treated for primary spinal intramedullary ependymomas between 2000 and 2020 were identified and data were gathered on preoperative neurological exam, radiographic characteristics, operative details, and postoperative neurological outcome. Neurological status was graded on the modified McCormick Scale (MMS). Neurological worsening immediately postoperatively and at last follow-up were defined by ≥ 1 MMS grade deterioration. Decision-tree analyses were also performed to identify independent predictors of new neurological deficits.

Results

Seventy patients were identified; mean age 45.4 ± 12.7; 60% male. Forty-eight patients (68.6%) had tumor-associated syrinxes, were more common among males (68.8%) and cervical lesions (68.8 vs. 31.8%; P = 0.005). Postoperatively patients with syrinxes had better MMS (P = 0.035) and were less likely to require a gait aid (39.6 vs. 81.8; P = 0.002). This latter difference persisted to last follow-up (22.9 vs. 59.1%; P = 0.006). On decision-tree analysis the strongest predictors of long-term neurological worsening were advanced age (≥ 63 years) and worse baseline neurological function. Worsened neurological status in the immediate postoperative period was best predicted by thoracic localization, the presence of a hemosiderin cap, and longer craniocaudal extension.

Conclusion

For spinal ependymomas, tumor-associated syrinxes may portend decreased risk for immediate postoperative neurologic deficits but do not predict long-term neurological outcomes (MMS) or odds of successful gross total resection. Thoracic localization appears to best predict new immediate postoperative deficits, and worse baseline neurological function and advanced age best predict long-term deficits.

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Abbreviations

CBTRUS:

Central Brain Tumor Registry of the United States

GTR:

Gross total resection

IMSCT:

Intramedullary spinal cord tumor

NF2:

Neurofibromatosis type 2

STR:

Subtotal resection

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA

    Zach Pennington, Anthony L. Mikula, Nikita Lakomkin, Fredric B. Meyer, W. Richard Marsh, Benjamin D. Elder, Mohamad Bydon, Jeremy L. Fogelson, William E. Krauss & Michelle J. Clarke

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  1. Zach Pennington
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  2. Anthony L. Mikula
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Correspondence to Zach Pennington.

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Disclosures

Zach Pennington - None, Anthony L Mikula - None, Nikita Lakomkin - None, Fredric B Meyer - None, W Richard Marsh - None, Benjamin D Elder - None, Mohamad Bydon - None, Jeremy Fogelson - None, William E Krauss - None, Michelle J Clarke - None.

IRB approval

IRB approval was obtained prior to initiation of the present study (11-007715).

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Previous presentations: Part of this was presented at the 2013 Congress of Neurological Surgeons Annual Meeting in San Francisco, CA, October 22–24, 2013.

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Pennington, Z., Mikula, A.L., Lakomkin, N. et al. Impact of tumor-associated syrinx on outcomes following resection of primary ependymomas of the spinal cord. J Neurooncol 160, 725–733 (2022). https://doi.org/10.1007/s11060-022-04194-2

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