gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Outcome and management of patients with spinal ependymoma: A retrospective follow-up analysis of 44 adult patients

Meeting Abstract

  • V. Borger - Klinik für Neurochirurgie, Zentrum für Neurologie und Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • K. Franz - Klinik für Neurochirurgie, Zentrum für Neurologie und Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • C. Senft - Klinik für Neurochirurgie, Zentrum für Neurologie und Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • G. Marquardt - Klinik für Neurochirurgie, Zentrum für Neurologie und Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main
  • V. Seifert - Klinik für Neurochirurgie, Zentrum für Neurologie und Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.11.02

DOI: 10.3205/12dgnc382, URN: urn:nbn:de:0183-12dgnc3826

Published: June 4, 2012

© 2012 Borger et al.
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Outline

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Objective: In this study we evaluate a series of 44 consecutive patients with a spinal ependymoma (EP) elucidating the management, the progression-free survival, the overall survival and long-term clinical outcome

Methods: Medical charts and follow-up reports of 44 patients treated between 1998 and 2010 were retrospectively reviewed with respect to tumor localisation, operative treatment, histology, adjuvant treatment if applicable, progression-free survival and outcome. Outcome was evaluated with the KPS.

Results: 44 patients, aged 26–66 years (median 46 yrs., sex ratio f:m 1:1) were included in the study. Median follow-up was 42 months. Localisation was lumbar 63.7%, thoracic 15.9%, cervical 13.6% and thoraco-lumbar 6.8%. 5 patients had multifocal lesions. First-line treatment consisted of surgical resection with the goal of gross total resection (GTR) preserving neurological function. In 42 cases (95.4%) GTR was achieved. One patient (2.3%) underwent biopsy and one subtotal resection. The histology revealed EP WHO°II (50%), myxopapillary EP WHO°I (45.5%), papillary EP WHO°II (2.3%) and anaplastic EP WHO°III (2.3%). 12 patients (27.3%) suffered from transient complications, such as cerebrospinal fluid fistula: n=4 (9%), new paresis: n=3 (6.8%), cauda-syndrome: n=3 (6.8%), abscess: n=1 (2.3%) and extradural hematoma: n=1 (2.3%). Median post-operative KPS was 90 (60–100). 1 patient with EP WHO°II who developed spinal metastases was treated with adjuvant radiotherapy. 1 patient with EP WHO°III declined radiotherapy. 30 patients (60.8%) underwent post-operative staging with craniospinal MRI which showed a second tumor localisation in 1 patient. 1 patient suffered a tumor recurrence after a period of 49 months (EP WHO°II). Patients with biopsy or subtotal resection showed stable disease over a period of 21 and 12 months respectively.

Conclusions: Optimal treatment of spinal EP remains complete resection if feasible without impairment of neurological function. Patients should be monitored at regular intervals to detect recurrence or metastases in time. The necessity of adjuvant radiotherapy is controversially discussed. Even in case of subtotal resection or biopsy, a tumor can be stable over a long period without adjuvant therapy. However, evidence-based recommendations for the frequency of follow-up examinations, the necessity of cerebrospinal staging by MRI and the indication for radiotherapy are lacking. Given the low incidence of spinal EP, neurosurgeons should aim at multicenter evaluations.