Spinal Cord Ependymoma - Surgical Management and Outcome

Abstract

Background: Ependymoma is a common primary neoplasm of the spinal cord and filum terminale. Patients with spinal ependymoma usually experience gradual symptoms due to slow progression of the tumor; thus, early diagnosis can be challenging to make.

Objective: The objective of this study was to report 5 years' experience in treating spinal intramedullary ependymomas and to illustrate the advantage of aggressive complete resection whenever possible.

Patients and methods: Retrospective medical notes of all patients with spinal ependymoma treated surgically over a 5-year period between January 2003 and January 2008 were recorded. Clinical presentation, spinal level, extent of resection, and complications were recorded. A prolonged follow-up was documented.

Results: There were 20 patients - 11 males, and nine females -included in this study. Their median age was 48 years (range 3-75 years). In 18 patients, total gross resection was achieved. Subtotal resection was only possible in one patient due to surgical difficulty. One patient underwent biopsy and referred for further surgery and subsequently had total resection.

Conclusions: Radical total resection is achievable in spinal ependymomas, with minimal resultant morbidity.

Keywords: Ependymoma; intramedullary; myxopapillary; spinal tumors; spine.

Figure 1

Preoperative and postoperative T2 magnetic resonance imaging showing L1 ependymoma

Figure 2

Smear of resected ependymoma showing moderately glial derived and focally myxoid lesion

Figure 3

(a) Extensive cervical ependymoma with associated syrinx and (b) postoperative image showing total resection

Figure 4

Picture of a large cervicodorsal ependymoma resected en bloc