Journal of Neuro-Oncology

, Volume 57, Issue 2, pp 133–139 | Cite as

Surgical Outcome and Prognostic Factors of Spinal Intramedullary Ependymomas in Adults

  • Ung Kyu Chang
  • Woo Jin Choe
  • Sang Kee Chung
  • Chun Kee Chung
  • Hyun Jib Kim


The goal of treatment for spinal ependymoma is complete removal with minimal postoperative neurological deficit. The authors correlated the results of surgical management for spinal cord ependymoma with the rate of postoperative disease progression and the prognostic factors. Thirty-one cases of spinal ependymomas, surgically treated between 1979 and 1998, were retrospectively analyzed. The authors reviewed clinical features, radiological characteristics and operative findings for the surgical outcome analysis. Thirty-five percent of patients with preoperative Nurick's grade better than grade 4 showed improvement in functional status, whereas no improvement was observed in patients with preoperatively poorer functional status (P=0.05). The proportion of complete surgical removals was influenced by tumor location (40% in cases around the conus versus 97% in other regions, P=0.003) and histology (42% in the myxopapillary subtype versus 97% in the non-myxopapillary subtype, P=0.001). Disease progression was observed in six cases, the mean progression free interval after surgical removal was 83 months and the 5-year progression free rate was 70%. Disease progression was found in two out of 23 cases from the complete removal group and in four out of eight cases from the incomplete removal group (P=0.008). In the aspect of disease progression, the only statistically significant factor by multivariate analysis was the surgical extent of removal (P=0.010). Of those patients where there was incomplete removal, radiation therapy lead to improved clinical results, which were not statistically significant (P=0.27). In the surgical treatment of spinal cord ependymoma, preoperative functional status and the extent of removal were the significant prognostic factors influencing postoperative outcome. Early diagnosis is vital and complete removal of the tumor should be attempted in all surgical treatment of spinal ependymoma.

spinal ependymoma surgical extent tumor location histologic subtype radiation therapy prognosis 


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  1. 1.
    McCormick PC, Torres R, Post KD, Stein BM: Intramedullary ependymoma of the spinal cord. J Neurosurg 72: 523-532, 1990Google Scholar
  2. 2.
    Shaw EG, Evans RG, Scheithauer BW, Ilstrup DM, Earle JD: Radiotherapeutic management of adult intraspinal ependymomas. Int J Radiat Biol Phys 12: 323-327, 1986Google Scholar
  3. 3.
    Peschel RE, Kapp DS, Cardinale F, Manuelidis EE: Ependymomas of spinal cord. Int J Radiat Oncol Biol Phys 9: 1093-1096, 1983Google Scholar
  4. 4.
    Møck SJ, Løken A: Ependymoma. A follow-up study of 101 cases. Cancer 40: 907-915, 1977Google Scholar
  5. 5.
    Phillips DG: Surgical treatment of myelopathy with cervical spondylosis. J Neurol Neurosurg Psychiatry 36: 879-884, 1973Google Scholar
  6. 6.
    Epstein FJ, Farmer JP, Freed D: Adult intramedullary spinal cord ependymomas: The result of surgery in 38 patients. J Neurosurg 79: 204-209, 1993Google Scholar
  7. 7.
    Li MH, Holtas S: MR Imaging of spinal intramedullary tumors. Acta Radiol 32: 505-513, 1991Google Scholar
  8. 8.
    Blalock RL: Hydrosyringomyelia of the conus medullaris associated with a thoracic meningioma: case report. J Neurosurg 53: 833-835, 1981Google Scholar
  9. 9.
    Nagahiro S, Matsukado Y, Kuratsu J, Saito Y, Takamura S: Syringomyelia and syringobulbia associated with an ependymoma of the cauda equina involving the conus medullaris: case report. Neurosurgery 18(3): 357-360, 1986Google Scholar
  10. 10.
    Lohle PN, Wurzer HA, Hoogland PH, Seelen PJ, Go KG: The pathogenesis of syringomyelia in spinal cord ependymoma. Clin Neurol Neurosurg 96: 323-326, 1994Google Scholar
  11. 11.
    Samii M, Klekamp J: Surgical results of 100 intramedullary tumors in relation to accompanying syringomyelia. Neurosurgery 35: 865-873, 1994Google Scholar
  12. 12.
    Quencer RM, Gammal ET, Cohen G: Syringomyelia associated with intradural extramedullary masses of the spinal canal. AJNR 7: 143-148, 1986Google Scholar
  13. 13.
    Stoodley MA, Brown SA, Brown CJ, Jones NR: Arterial pulsation-dependent perivascular cerebrospinal fluid flow into the central canal in the sheep spinal cord. J Neurosurg 86: 686-693, 1997Google Scholar
  14. 14.
    Fine MJ, Kricheff II, Freed D, Epstein FJ: Spinal cord ependymomas; MR imaging features. Radiology 197: 655-658, 1995Google Scholar
  15. 15.
    Celli P, Cervoni L, Cantore G: Ependymoma of the filum terminalae: treatment and prognostic factors in a series of 28 cases. Acta Neurochir (Wien) 124: 99-103, 1993Google Scholar
  16. 16.
    Marks JE, Adler SJ: A comparative study of ependymomas by site of origin. Int J Radiat Oncol Biol Phys 8: 37-43, 1982Google Scholar
  17. 17.
    Wippold FJ 2nd, Smirniotopoulos JG, Moran CJ, Suojanen JN, Vollmer DG: MR imaging of Myxopapillary ependymoma: finding and value to determine extent of tumor and its relation to intraspinal structures. AJR 165: 1263-1267, 1995Google Scholar
  18. 18.
    Ferrante L, Mastronardi P, Celli P, Lunardi P, Acqui M, Fortuna A: Intramedullary spinal cord ependymomas-a study of 45 cases with long-term follow-up. Acta Neurochir (Wien) 119: 74-79, 1992Google Scholar
  19. 19.
    Rawlings CE, Giangaspero F, Burger PC, Bullard DE: Ependymomas: a clinicopathologic study. Surg Neurol 29: 271-281, 1988Google Scholar
  20. 20.
    Whitaker SJ, Bessell EM, Ashley SE, Bloom HJ, Bell BA, Brada M: Postoperative radiotherapy in the management of spinal cord ependymoma. J Neurosurg 74: 720-728, 1991Google Scholar
  21. 21.
    Garcia DM: Primary spinal cord tumors treated with surgery and postoperative irradiation. Int J Radiat Oncol Biol Phys 11: 1933-1939, 1985Google Scholar
  22. 22.
    Salazar O, Rubin P, Bassano D, Marcial VA: Improved survival of patients with intracranial ependymomas by irradiation dose selection and field extension. Cancer 35: 1563-1573, 1975Google Scholar
  23. 23.
    Sgouros S, Malluci CL, Jackowski A: Spinal ependymomas-The value of postoperative radiotherapy for residual disease control. Br J Neurosurg 10: 559-566, 1996Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Ung Kyu Chang
    • 1
  • Woo Jin Choe
    • 1
  • Sang Kee Chung
    • 1
  • Chun Kee Chung
    • 1
  • Hyun Jib Kim
    • 1
  1. 1.Department of NeurosurgerySeoul National University College of MedicineSeoulKorea

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