Advertisement

Myxopapillary Ependymomas

  • Ibrahim Omerhodžić
  • Mirza Pojskić
  • Kenan I. Arnautović
Chapter

Abstract

Myxopapillary ependymomas (MPEs) are World Health Organization (WHO) Grade I tumors that arise from the ependyma of the filum terminale located in the area of the conus medullaris and cauda equina. MPE is a slow-growing tumor most frequently found in adults between 30 and 50 years of age. They constitute around 13% of all ependymomas and as many as 90% of all tumors in the conus medullaris. The recommended treatment for patients with MPE is gross total resection; patients undergoing subtotal resection usually also undergo radiotherapy. Both microsurgical technique and spinal cord monitoring are indispensable to achieve total removal of MPEs and to obtain improvement of neurological recovery. Complete resection without capsular violation—the so called marginal en bloc resection—can be curative, and is often simply accomplished by resecting the filum above and below the mass. Nevertheless, this technique can be technically difficult in a given tumor based on tumor size, shape, and anatomical relation to the cauda equine nerves or spinal cord. Surgical morbidity in experienced hands is low with good chances for postoperative clinical improvements. Ten-year survival is reported to be 92–100% with 10-year progression-free survival (PFS) of 61.2%. Although myxopapillary ependymomas are classified as benign tumors, dissemination and local recurrence pose a major challenge in their clinical treatment. In the literature, dissemination and distant treatment failure are consistently described as occurring approximately 30% of the time. Recurrence rates have been reported around 15% following gross-total resection, and 30% following subtotal resection. Up to one-third of adult patients can display metastases at the initial diagnosis, which is why total spine magnetic resonance imaging (MRI) with MRI of the head is recommended in the initial workup. Radiotherapy may be recommended when a piecemeal resection is performed due to the rupture of the tumor capsule during surgery to prevent the local recurrence and CSF dissemination.

Keywords

Myxopapillary Ependymoma Gross Total resection Surgical technique Adjuvant radiotherapy Recurrence Primary seeding Secondary seeding 

Supplementary material

Video 15.1

Microsurgical resection of myxopapillary ependymoma of the lumbar spine in patient from Fig. 15.4. (MPG 432032 kb)

References

  1. 1.
    JW K. Primary tumors of the spinal cord and intradural filum terminale. In: W P (ed) Cytology and cellular pathology of the nervous system, vol 3. Paul B Hoeber, New York, 1932; pp 993–1025.Google Scholar
  2. 2.
    Rawlings CE, Giangaspero F, Burger PC, Bullard DE. Ependymomas: a clinicopathologic study. Surg Neurol. 1988;29(4):271–81.PubMedGoogle Scholar
  3. 3.
    Akyurek S, Chang EL, Yu TK, Little D, Allen PK, McCutcheon I, Mahajan A, Maor MH, Woo SY. Spinal myxopapillary ependymoma outcomes in patients treated with surgery and radiotherapy at M.D. Anderson Cancer center. J Neuro-Oncol. 2006;80(2):177–83.  https://doi.org/10.1007/s11060-006-9169-2.Google Scholar
  4. 4.
    Bates JE, Choi G, Milano MT. Myxopapillary ependymoma: a SEER analysis of epidemiology and outcomes. J Neuro-Oncol. 2016;129(2):251–8.  https://doi.org/10.1007/s11060-016-2167-0.Google Scholar
  5. 5.
    Arnautovic K, Arnautovic A. Extramedullary intradural spinal tumors: a review of modern diagnostic and treatment options and a report of a series. Bosn J Basic Med Sci. 2009;9(Suppl 1):40–5.PubMedGoogle Scholar
  6. 6.
    Samii JKM. Surgery of spinal tumors. Berlin: Springer; 2007.  https://doi.org/10.1007/978-3-540-44715-3.Google Scholar
  7. 7.
    Klekamp J. Spinal ependymomas. Part 2: Ependymomas of the filum terminale. Neurosurg Focus. 2015;39(2):E7.  https://doi.org/10.3171/2015.5.FOCUS15151.PubMedGoogle Scholar
  8. 8.
    Schiffer D, Chiò A, Giordana MT, Migheli A, Palma L, Pollo B, Soffietti R, Tribolo A. Histologic prognostic factors in ependymoma. Childs Nerv Syst. 1991;7(4):177–82.PubMedGoogle Scholar
  9. 9.
    Sonneland PR, Scheithauer BW, Onofrio BM. Myxopapillary ependymoma. A clinicopathologic and immunocytochemical study of 77 cases. Cancer. 1985;56(4):883–93.PubMedGoogle Scholar
  10. 10.
    Celli P, Cervoni L, Cantore G. Ependymoma of the filum terminale: treatment and prognostic factors in a series of 28 cases. Acta Neurochir. 1993;124(2–4):99–103.PubMedGoogle Scholar
  11. 11.
    Khan NR, Vanlandingham M, O'Brien T, Boop FA, Arnautović K. Primary seeding of Myxopapillary Ependymoma: different disease in adult population? Case report and review of literature. World Neurosurg 99:812.e821-812.e826. 2017;  https://doi.org/10.1016/j.wneu.2016.12.022.PubMedGoogle Scholar
  12. 12.
    Fassett DR, Pingree J, Kestle JR. The high incidence of tumor dissemination in myxopapillary ependymoma in pediatric patients. Report of five cases and review of the literature. J Neurosurg. 2005;102(1 Suppl):59–64.  https://doi.org/10.3171/ped.2005.102.1.0059.PubMedGoogle Scholar
  13. 13.
    Weber DC, Wang Y, Miller R, Villà S, Zaucha R, Pica A, Poortmans P, Anacak Y, Ozygit G, Baumert B, Haller G, Preusser M, Li J. Long-term outcome of patients with spinal myxopapillary ependymoma: treatment results from the MD Anderson Cancer Center and institutions from the rare Cancer network. Neuro-Oncology. 2015;17(4):588–95.  https://doi.org/10.1093/neuonc/nou293.PubMedGoogle Scholar
  14. 14.
    Bagley CA, Wilson S, Kothbauer KF, Bookland MJ, Epstein F, Jallo GI. Long term outcomes following surgical resection of myxopapillary ependymomas. Neurosurg Rev. 2009;32(3):321–34.; discussion 334.  https://doi.org/10.1007/s10143-009-0190-8.PubMedGoogle Scholar
  15. 15.
    Chan HS, Becker LE, Hoffman HJ, Humphreys RP, Hendrick EB, Fitz CR, Chuang SH. Myxopapillary ependymoma of the filum terminale and cauda equina in childhood: report of seven cases and review of the literature. Neurosurgery. 1984;14(2):204–10.PubMedGoogle Scholar
  16. 16.
    Chen X, Li C, Che X, Chen H, Liu Z. Spinal myxopapillary ependymomas: a retrospective clinical and immunohistochemical study. Acta Neurochir. 2016;158(1):101–7.  https://doi.org/10.1007/s00701-015-2637-8.PubMedGoogle Scholar
  17. 17.
    Gu S, Gu W, Shou J, Xiong J, Liu X, Sun B, Yang D, Xie R. The molecular feature of HOX gene family in the intramedullary spinal tumors. Spine (Phila Pa 1976). 2017;42(5):291–7.  https://doi.org/10.1097/BRS.0000000000000889.Google Scholar
  18. 18.
    Mendrzyk F, Korshunov A, Benner A, Toedt G, Pfister S, Radlwimmer B, Lichter P. Identification of gains on 1q and epidermal growth factor receptor overexpression as independent prognostic markers in intracranial ependymoma. Clin Cancer Res. 2006;12(7 Pt 1):2070–9.  https://doi.org/10.1158/1078-0432.CCR-05-2363.PubMedGoogle Scholar
  19. 19.
    Verma A, Zhou H, Chin S, Bruggers C, Kestle J, Khatua S. EGFR as a predictor of relapse in myxopapillary ependymoma. Pediatr Blood Cancer. 2012;59(4):746–8.  https://doi.org/10.1002/pbc.24054.PubMedGoogle Scholar
  20. 20.
    Mack SC, Agnihotri S, Bertrand KC, Wang X, Shih DJ, Witt H, Hill N, Zayne K, Barszczyk M, Ramaswamy V, Remke M, Thompson Y, Ryzhova M, Massimi L, Grajkowska W, Lach B, Gupta N, Weiss WA, Guha A, Hawkins C, Croul S, Rutka JT, Pfister SM, Korshunov A, Pekmezci M, Tihan T, Philips JJ, Jabado N, Zadeh G, Taylor MD. Spinal Myxopapillary Ependymomas demonstrate a Warburg phenotype. Clin Cancer Res. 2015;21(16):3750–8.  https://doi.org/10.1158/1078-0432.CCR-14-2650.PubMedGoogle Scholar
  21. 21.
    Rivierez M, Oueslati S, Philippon J, Pradat P, Foncin JF, Muckensturm B, Dorwling-Carter D, Cornu P. Ependymoma of the intradural filum terminale in adults. 20 cases. Neurochirurgie. 1990;36(2):96–107.PubMedGoogle Scholar
  22. 22.
    Kraetzig T, McLaughlin L, Bilsky MH, Laufer I. Metastases of spinal myxopapillary ependymoma: unique characteristics and clinical management. J Neurosurg Spine. 2018;28(2):201–8.  https://doi.org/10.3171/2017.5.SPINE161164.PubMedGoogle Scholar
  23. 23.
    Lonjon M, Von Langsdorf D, Lefloch S, Rahbi M, Rasendrarijao D, Michiels JF, Paquis P, Grellier P. Factors influencing recurrence and role of radiotherapy in filum terminale ependymomas. 14 cases and review of the literature. Neurochirurgie. 2001;47(4):423–9.PubMedGoogle Scholar
  24. 24.
    Balasubramaniam S, Tyagi DK, Desai KI, Dighe MP. Outcome analysis in cases of spinal Conus cauda Ependymoma. J Clin Diagn Res. 2016;10(9):PC12–6.  https://doi.org/10.7860/JCDR/2016/22736.8458.PubMedGoogle Scholar
  25. 25.
    Morimoto D, Isu T, Kim K, Isobe M, Takahashi T, Ishida Y, Takei H, Morita A. Surgical treatment for posttraumatic hemorrhage inside a filum terminale myxopapillary ependymoma: a case report and literature review. Eur Spine J. 2016;25(Suppl 1):239–44.  https://doi.org/10.1007/s00586-016-4521-5.PubMedGoogle Scholar
  26. 26.
    Terao T, Kato N, Ishii T, Hatano K, Takeishi H, Kakizaki S, Tani S, Murayama Y. Spontaneous hemorrhage of a spinal Ependymoma in the filum Terminale presenting with acute cauda Equina syndrome: case report. NMC Case Rep J. 2016;3(3):91–5.  https://doi.org/10.2176/nmccrj.cr.2015-0295.PubMedGoogle Scholar
  27. 27.
    Abul-Kasim K, Thurnher MM, McKeever P, Sundgren PC. Intradural spinal tumors: current classification and MRI features. Neuroradiology. 2008;50(4):301–14.  https://doi.org/10.1007/s00234-007-0345-7.PubMedGoogle Scholar
  28. 28.
    Sakai Y, Matsuyama Y, Katayama Y, Imagama S, Ito Z, Wakao N, Kanemura T, Yoshida G, Sato K, Ando T, Nakamura H, Kato F, Yukawa Y, Ito K, Ishiguro N. Spinal myxopapillary ependymoma: neurological deterioration in patients treated with surgery. Spine (Phila Pa 1976). 2009;34(15):1619–24.  https://doi.org/10.1097/BRS.0b013e3181a983d8.Google Scholar
  29. 29.
    Shors SM, Jones TA, Jhaveri MD, Huckman MS. Best cases from the AFIP: myxopapillary ependymoma of the sacrum. Radiographics. 2006;26(Suppl 1):S111–6.  https://doi.org/10.1148/rg.26si065020.PubMedGoogle Scholar
  30. 30.
    Anderson MS. Myxopapillary ependymomas presenting in the soft tissue over the sacrococcygeal region. Cancer. 1966;19(4):585–90.PubMedGoogle Scholar
  31. 31.
    Quraishi NA, Wolinsky JP, Bydon A, Witham T, Gokaslan ZL. Giant destructive myxopapillary ependymomas of the sacrum. J Neurosurg Spine. 2010;12(2):154–9.  https://doi.org/10.3171/2009.9.SPINE08968.PubMedGoogle Scholar
  32. 32.
    Hayashi T, Haba R, Kushida Y, Kadota K, Katsuki N, Bando K, Shibuya S, Matsunaga T. Cytopathologic characteristics and differential diagnostic considerations of osteolytic myxopapillary ependymoma. Diagn Cytopathol. 2014;42(9):778–83.  https://doi.org/10.1002/dc.23033.PubMedGoogle Scholar
  33. 33.
    Wang M, Wang H, Zhou Y, Zhan R, Wan S. Myxopapillary ependymoma in the third ventricle area and sacral canal: dropped or retrograde metastasis? Neurol Med Chir (Tokyo). 2013;53(4):237–41.Google Scholar
  34. 34.
    Graf M, Blaeker H, Otto HF. Extraneural metastasizing ependymoma of the spinal cord. Pathol Oncol Res. 1999;5(1):56–60.PubMedGoogle Scholar
  35. 35.
    Fassett DR, Schmidt MH. Lumbosacral ependymomas: a review of the management of intradural and extradural tumors. Neurosurg Focus. 2003;15(5):E13.PubMedGoogle Scholar
  36. 36.
    Cervoni L, Celli P, Cantore G, Fortuna A. Intradural tumors of the cauda equina: a single institution review of clinical characteristics. Clin Neurol Neurosurg. 1995;97(1):8–12.PubMedGoogle Scholar
  37. 37.
    Parsa AT, Fiore AJ, McCormick PC, Bruce JN. Genetic basis of intramedullary spinal cord tumors and therapeutic implications. J Neuro-Oncol. 2000;47(3):239–51.Google Scholar
  38. 38.
    Asazuma T, Toyama Y, Suzuki N, Fujimura Y, Hirabayshi K. Ependymomas of the spinal cord and cauda equina: an analysis of 26 cases and a review of the literature. Spinal Cord. 1999;37(11):753–9.PubMedGoogle Scholar
  39. 39.
    Nakamura M, Ishii K, Watanabe K, Tsuji T, Matsumoto M, Toyama Y, Chiba K. Long-term surgical outcomes for myxopapillary ependymomas of the cauda equina. Spine (Phila Pa 1976). 2009;34(21):E756–60.  https://doi.org/10.1097/BRS.0b013e3181b34d16.Google Scholar
  40. 40.
    Lehecka M, Laakso A, Hernesniemi J (2011) Helsinki microneurosurgery basics and tricks. Aesculap AG | D-NE11002,Google Scholar
  41. 41.
    McCormick PC. Microsurgical enbloc resection of myxopapillary cauda equina ependymoma. Neurosurg Focus 37 Suppl 2:Video 7. 2014;  https://doi.org/10.3171/2014.V3.FOCUS14272.
  42. 42.
    Hoving EW, Haitsma E, Oude Ophuis CM, Journée HL. The value of intraoperative neurophysiological monitoring in tethered cord surgery. Childs Nerv Syst. 2011;27(9):1445–52.  https://doi.org/10.1007/s00381-011-1471-4.PubMedGoogle Scholar
  43. 43.
    Krassioukov AV, Sarjeant R, Arkia H, Fehlings MG. Multimodality intraoperative monitoring during complex lumbosacral procedures: indications, techniques, and long-term follow-up review of 61 consecutive cases. J Neurosurg Spine. 2004;1(3):243–53.  https://doi.org/10.3171/spi.2004.1.3.0243.PubMedGoogle Scholar
  44. 44.
    Quiñones-Hinojosa A, Gadkary CA, Gulati M, von Koch CS, Lyon R, Weinstein PR, Yingling CD. Neurophysiological monitoring for safe surgical tethered cord syndrome release in adults. Surg Neurol. 2004;62(2):127–33.; discussion 133-125.  https://doi.org/10.1016/j.surneu.2003.11.025.PubMedGoogle Scholar
  45. 45.
    Arnautovic KI, Kovacevic M. CSF-related complications after Intradural spinal tumor surgery: utility of an autologous fat graft. Med Arch. 2016;70(6):460–5.  https://doi.org/10.5455/medarh.2016.70.460-465.PubMedGoogle Scholar
  46. 46.
    Chang UK, Choe WJ, Chung SK, Chung CK, Kim HJ. Surgical outcome and prognostic factors of spinal intramedullary ependymomas in adults. J Neuro-Oncol. 2002;57(2):133–9.Google Scholar
  47. 47.
    Lee SH, Chung CK, Kim CH, Yoon SH, Hyun SJ, Kim KJ, Kim ES, Eoh W, Kim HJ. Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea spinal oncology research group. Neuro-Oncology. 2013;15(7):921–9.  https://doi.org/10.1093/neuonc/not038.PubMedGoogle Scholar
  48. 48.
    Ross DA, McKeever PE, Sandler HM, Muraszko KM. Myxopapillary ependymoma. Results of nucleolar organizing region staining. Cancer. 1993;71(10):3114–8.PubMedGoogle Scholar
  49. 49.
    Pica A, Miller R, Villà S, Kadish SP, Anacak Y, Abusaris H, Ozyigit G, Baumert BG, Zaucha R, Haller G, Weber DC. The results of surgery, with or without radiotherapy, for primary spinal myxopapillary ependymoma: a retrospective study from the rare cancer network. Int J Radiat Oncol Biol Phys. 2009;74(4):1114–20.  https://doi.org/10.1016/j.ijrobp.2008.09.034.PubMedGoogle Scholar
  50. 50.
    Kucia EJ, Maughan PH, Kakarla UK, Bambakidis NC, Spetzler RF. Surgical technique and outcomes in the treatment of spinal cord ependymomas: part II: myxopapillary ependymoma. Neurosurgery 68 (1 Suppl Operative):90-94.; discussion 94. 2011;  https://doi.org/10.1227/NEU.0b013e3181fdf912.Google Scholar
  51. 51.
    Al-Habib A, Al-Radi OO, Shannon P, Al-Ahmadi H, Petrenko Y, Fehlings MG. Myxopapillary ependymoma: correlation of clinical and imaging features with surgical resectability in a series with long-term follow-up. Spinal Cord. 2011;49(10):1073–8.  https://doi.org/10.1038/sc.2011.67.PubMedGoogle Scholar
  52. 52.
    Agbahiwe HC, Wharam M, Batra S, Cohen K, Terezakis SA. Management of pediatric myxopapillary ependymoma: the role of adjuvant radiation. Int J Radiat Oncol Biol Phys. 2013;85(2):421–7.  https://doi.org/10.1016/j.ijrobp.2012.05.001.PubMedGoogle Scholar
  53. 53.
    Tsai CJ, Wang Y, Allen PK, Mahajan A, McCutcheon IE, Rao G, Rhines LD, Tatsui CE, Armstrong TS, Maor MH, Chang EL, Brown PD, Li J. Outcomes after surgery and radiotherapy for spinal myxopapillary ependymoma: update of the MD Anderson Cancer Center experience. Neurosurgery. 2014;75(3):205–14.; discussion 213-204.  https://doi.org/10.1227/NEU.0000000000000408.PubMedGoogle Scholar
  54. 54.
    Kukreja S, Ambekar S, Sin AH, Nanda A. Cumulative survival analysis of patients with spinal myxopapillary ependymomas in the first 2 decades of life. J Neurosurg Pediatr. 2014;13(4):400–7.  https://doi.org/10.3171/2014.1.PEDS13532.PubMedGoogle Scholar
  55. 55.
    Kukreja S, Ambekar S, Sharma M, Sin AH, Nanda A. Outcome predictors in the management of spinal myxopapillary ependymoma: an integrative survival analysis. World Neurosurg. 2015;83(5):852–9.  https://doi.org/10.1016/j.wneu.2014.08.006.PubMedGoogle Scholar
  56. 56.
    Abdulaziz M, Mallory GW, Bydon M, De la Garza RR, Ellis JA, Laack NN, Marsh WR, Krauss WE, Jallo G, Gokaslan ZL, Clarke MJ. Outcomes following myxopapillary ependymoma resection: the importance of capsule integrity. Neurosurg Focus. 2015;39(2):E8.  https://doi.org/10.3171/2015.5.FOCUS15164.
  57. 57.
    Khalatbari MR, Hamidi M, Moharamzad Y, Shobeiri E. Primary multifocal myxopapillary ependymoma of the filum terminale. J Neurosurg Sci. 2016;60(4):424–9.PubMedGoogle Scholar
  58. 58.
    Chao ST, Kobayashi T, Benzel E, Reddy CA, Stevens GH, Prayson RA, Kalfas I, Schlenk R, Krishnaney A, Steinmetz MP, Bingaman W, Hahn J, Suh JH. The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas. J Neurosurg Spine. 2011;14(1):59–64.  https://doi.org/10.3171/2010.9.SPINE09920.PubMedGoogle Scholar
  59. 59.
    Wang H, Zhang S, Rehman SK, Zhang Z, Li W, Makki MS, Zhou X. Clinicopathological features of myxopapillary ependymoma. J Clin Neurosci. 2014;21(4):569–73.  https://doi.org/10.1016/j.jocn.2013.05.028.PubMedGoogle Scholar
  60. 60.
    Feldman WB, Clark AJ, Safaee M, Ames CP, Parsa AT. Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children: a systematic review. J Neurosurg Spine. 2013;19(4):471–6.  https://doi.org/10.3171/2013.6.SPINE12927.PubMedGoogle Scholar
  61. 61.
    Celli P, Cervoni L, Salvati M, Cantore G. Recurrence from filum terminale ependymoma 42 years after 'total' removal and radiotherapy. J Neuro-Oncol. 1997;34(2):153–6.Google Scholar
  62. 62.
    Schild SE, Nisi K, Scheithauer BW, Wong WW, Lyons MK, Schomberg PJ, Shaw EG. The results of radiotherapy for ependymomas: the Mayo Clinic experience. Int J Radiat Oncol Biol Phys. 1998;42(5):953–8.PubMedGoogle Scholar
  63. 63.
    Arnautović KI, Al-Mefty O. Surgical seeding of chordomas. Neurosurg Focus. 2001;10(3):E7.PubMedGoogle Scholar
  64. 64.
    De Falco R, Scarano E, Di Celmo D, Civetta F, Guarnieri L. Concomitant localization of a myxopapillary ependymoma at the middle thoracic part of the spinal cord and at the distal part of the filum terminale. Case report. J Neurosurg Sci. 2008;52(3):87–91.PubMedGoogle Scholar
  65. 65.
    Woesler B, Moskopp D, Kuchelmeister K, Schul C, Wassmann H. Intracranial metastasis of a spinal myxopapillary ependymoma. A case report. Neurosurg Rev. 1998;21(1):62–5.PubMedGoogle Scholar
  66. 66.
    Bandopadhayay P, Silvera VM, Ciarlini PD, Malkin H, Bi WL, Bergthold G, Faisal AM, Ullrich NJ, Marcus K, Scott RM, Beroukhim R, Manley PE, Chi SN, Ligon KL, Goumnerova LC, Kieran MW. Myxopapillary ependymomas in children: imaging, treatment and outcomes. J Neuro-Oncol. 2016;126(1):165–74.  https://doi.org/10.1007/s11060-015-1955-2.Google Scholar
  67. 67.
    Al-Hussaini M, Herron B. Metastasizing myxopapillary ependymoma. Histopathology. 2005;46(4):469–70.  https://doi.org/10.1111/j.1365-2559.2004.02009.x.PubMedGoogle Scholar
  68. 68.
    Bardales RH, Porter MC, Sawyer JR, Mrak RE, Stanley MW. Metastatic myxopapillary ependymoma: report of a case with fine-needle aspiration findings. Diagn Cytopathol. 1994;10(1):47–53.PubMedGoogle Scholar
  69. 69.
    Plans G, Brell M, Cabiol J, Villà S, Torres A, Acebes JJ. Intracranial retrograde dissemination in filum terminale myxopapillary ependymomas. Acta Neurochir. 2006;148(3):343–6.; discussion 346.  https://doi.org/10.1007/s00701-005-0693-1.PubMedGoogle Scholar
  70. 70.
    Andoh H, Kawaguchi Y, Seki S, Asanuma Y, Fukuoka J, Ishizawa S, Kimura T. Multi-focal Myxopapillary Ependymoma in the lumbar and sacral regions requiring Cranio-spinal radiation therapy: a case report. Asian Spine J. 2011;5(1):68–72.  https://doi.org/10.4184/asj.2011.5.1.68.PubMedGoogle Scholar
  71. 71.
    Rezai AR, Woo HH, Lee M, Cohen H, Zagzag D, Epstein FJ. Disseminated ependymomas of the central nervous system. J Neurosurg. 1996;85(4):618–24.  https://doi.org/10.3171/jns.1996.85.4.0618.PubMedGoogle Scholar
  72. 72.
    Yener U, Güdük M, Ekşi M, Aytar MH, Sav A, Özgen S (2016) Concomitant double tumors of Myxopapillary Ependymoma presented at cauda Equina-filum Terminale in adult patient. Korean J Spine 13(1):33–36.  https://doi.org/10.14245/kjs.2016.13.1.33.PubMedGoogle Scholar
  73. 73.
    Al-Halabi H, Montes JL, Atkinson J, Farmer JP, Freeman CR. Adjuvant radiotherapy in the treatment of pediatric myxopapillary ependymomas. Pediatr Blood Cancer. 2010;55(4):639–43.  https://doi.org/10.1002/pbc.22614.PubMedGoogle Scholar
  74. 74.
    Fujiwara Y, Manabe H, Izumi B, Shima T, Adachi N. Remarkable efficacy of temozolomide for relapsed spinal myxopapillary ependymoma with multiple recurrence and cerebrospinal dissemination: a case report and literature review. Eur Spine J. 2017;27:421–5.  https://doi.org/10.1007/s00586-017-5413-z.PubMedGoogle Scholar
  75. 75.
    Fegerl G, Marosi C. Stabilization of metastatic myxopapillary ependymoma with sorafenib. Rare Tumors. 2012;4(3):134–7.  https://doi.org/10.4081/rt.2012.e42.Google Scholar
  76. 76.
    Schweitzer JS, Batzdorf U. Ependymoma of the cauda equina region: diagnosis, treatment, and outcome in 15 patients. Neurosurgery. 1992;30(2):202–7.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ibrahim Omerhodžić
    • 1
  • Mirza Pojskić
    • 2
  • Kenan I. Arnautović
    • 3
    • 1
  1. 1.Department of NeurosurgeryClinical Center University of SarajevoSarajevoBosnia and Herzegovina
  2. 2.Department of NeurosurgeryUniversity of MarburgMarburgGermany
  3. 3.Semmes MurpheyMemphisUSA

Personalised recommendations