gms | German Medical Science

Objective: A considerable number of patients suffer delayed neurological deficits even after a successful removal of intramedullary spinal cord ependymoma. The underlying pathology remains unknown. Radiological findings could be an explanation for poor outcome after surgery on intramedullary spinal cord ependymoma.

Methods: We conducted a retrospective study of all cases treated from 1980 to 2016 in our department. Included were all patients with intramedullary spinal cord ependymoma treated with microsurgical excision. The cross-sectional area (CSA) of the spinal cord at the level of the former performed surgery was compared in MRI scans with postoperatively, adjacent not affected levels and with control group.

Results: 54 patients with an intramedullary spinal cord lesion were treated in this period. Ependymoma was the predominant tumor (28) followed by intramedullary gliomas and vascular lesions. Mean age was 48.2 ± 10.5 years with a female predominance (f=16, m=12). An unfavorable outcome was observed in 53% of the patients after an initially uneventful postoperative course. The cross-sectional area of the spinal cord was significantly reduced in these patients. Sagittal and axial spinal MRI showed spinal cord narrowing due to atrophic changes in the area of the performed surgery in 53 % of patients with resected ependymoma after a mean follow-up time of 9 years. Functional outcome in ependymoma was significantly associated with spinal cord atrophy (p< 0.05).

Conclusion: Spinal cord atrophy seems to be a predicting factor in long term outcome after surgical removal of intramedullary spinal cord ependymoma.