gms | German Medical Science

Objective: Current literature supports early surgical treatment for spinal ependymoma. The preoperative neurological status is considered an independent predictor of functional outcome. In this study, we aimed to determine whether this also applies to the subtype of filum terminale ependymomas, which are benign, slow growing tumors with a late onset of symptoms, mainly due to their extramedullary location.

Method: Data from patients with filum terminale ependymomas who underwent surgery between 1984 and 2015 were analyzed. The neurological status before and after surgery (day of discharge) was determined using the McCormick Score. An improved score or preservation of the preoperative status was considered a favorable outcome. The role of other parameters, such as extent of resection and cerebrospinal fluid (CSF) leak were also investigated and compared to the postoperative outcome.

Results: A total of 47 patients (26 male / 21 female, mean age of 45,7 years) with spinal ependymoma adjacent to the filum terminale were included. An improved or preserved McCormick Score after surgery was observed in 42 patients (89,4%) while a worsening of the McCormick Score was observed in 5 patients (10,6%). In all patients with favorable outcome, a preoperative McCormick Score of 2 and better was documented, whereas only 3 (60%) patients with unfavorable outcome scored 2 or better before surgery (p < 0,01). Out of 41 patients with a total resection, 37 had a favorable outcome. 5 patients developed a CSF leak, 4 of which showed a favorable outcome. Both the extent of resection and the development of a CSF leak showed no significant influence on the postoperative outcome.

Conclusions: The overall outcome after surgical resection of spinal ependymomas adjacent to the filum terminale is good. Patients with a preoperative McCormick Score of 2 and better had significantly better chances of an improved or stable neurological status after surgery than patients with a score of 3 and more. The extent of resection or the occurrence of a CSF leak did not affect the outcome. Our findings favour early surgical treatment of filum terminale ependymomas.