Artikel
Microsurgery for spinal cord ependymomas
Mikrochirurgische Behandlung spinaler Ependymome
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Autoren
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A. Boström
- Neurochirurgische Klinik der Medizinischen Universität Bonn
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M. Feuß
- Neurochirurgische Klinik der Medizinischen Universität Bonn
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M. v. Lehe
- Neurochirurgische Klinik der Medizinischen Universität Bonn
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J.P. Boström
- Neurochirurgische Klinik der Medizinischen Universität Bonn
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J. Schramm
- Neurochirurgische Klinik der Medizinischen Universität Bonn
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M. Simon
- Neurochirurgische Klinik der Medizinischen Universität Bonn
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: To evaluate the oncological outcome of patients with a spinal cord ependymoma, who were primarily treated with microsurgery.
Methods: Between 1987 and 2007, 58 patients (34 men, 24 women) underwent surgical therapy for a spinal cord ependymoma at our institution. Median follow-up was 60 months (range: 1–195). Patients' charts, operative and histological reports were analysed. The neurological status of the patients was recorded using the McCormick grading system. Standard therapy consisted of a complete tumor resection whenever feasible. Progression-free survival (PFS) was estimated by use of the Kaplan-Meier technique.
Results: Before the operation 1 patient was in McCormick grade 4, 15 patients were in grade 3, 28 in grade 2 and 14 in grade 1. After the operation 4 patients were in grade 4, 10 in grade 3, 29 in grade 2, 15 in grade 1. In 39 patients the tumor had an intramedullary location, in 19 cases the tumor was in an exclusively extramedullary location. Histopathological findings were ependymoma WHO grade I (myxopapillary) in 16 patients, ependymoma grade II in 39 patients, and WHO grade III (anaplastic) epndymoma in 3 patients. Only patients with grade III ependymoma received adjuvant therapy: radiation therapy alone in two cases, radiation therapy and subsequent chemotherapy at tumor recurrence 3 years later in another case. Recurrent tumor was diagnosed in 6/58 (10%) patients including 3 (50%) patients with a myxopapillary ependymoma, 2 patients with a grade II and 1 patient with a grade III ependymoma. In 4 cases the tumor was incompletely resected. Recurrences occurred between 6-59 months after the operation. The 5-, 10- and 15-year PFS were 83,0% each.
Conclusions: Functional outcomes after surgical therapy for spinal cord ependymomas are generally good. Recurrence rates ranging from 18-40% have been reported in the literature. Our results (recurrence rate 10%) compare favourably with these figures. The prognosis after surgery for myxopapillary ependymomas seems to be worse than generally believed.
