Artikel
Single-centre experience in treatment of spinal ependymom
Single-Center Erfahrungen in der Behandlung des spinalen Ependymoms
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Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Intramedullary spinal cord tumors are rare and despite surgical improvement still challenging pathologies. The most common entity in adults are ependymomas. Surgical treatment is the first line therapy to prevent neurological deficits due to tumor growth or myelon edema. Gross total resection (GTR) is the therapeutic goal, as it is associated with an increased overall survival. The aim of this study was to evaluate individual course of the disease, treatment regimens and outcome concerning grade of resection, recurrent tumor and neurological status of patients who underwent neurosurgical treatment.
Methods: In this retrospective study, patients who underwent surgical resection of spinal ependymoma between 1990–2017, were included. Neurological status was described using Frankel Classification grading system. Resection was performed with standard microsurgical conditions, intraoperative monitoring of somatosensory and motor-evoked potentials was applied in all patients. In 47 patients, a maximum follow-up of 120 months was achieved.
Results: 135 patients were included, consisting of 71 males and 64 females. The mean age was 45.6 years. 88% of the patients presented with pain, followed by sensory deficits (14.1%) or paresis (11.1%). Tumors were located in lumbar spine (n=58), thoracic spine (n=40) and cervical spine (n=37). Histologically, WHO °II ependymoma was most frequent (48.1%), followed by ependymoma WHO °I (46.6%). 5.3% of the patients had WHO °III tumor. In 119 cases (88.1%) GTR was achieved. Although all patients with ependymoma WHO °III received postoperative radiotherapy and GTR was achieved in 71.4% of cases, 85.7% of this cohort had a recurrent tumor during follow up. Postoperatively we observed neurological deterioration, as shown by an increase of Frankel grade A+B (motor and sensory deficits) from 3.7% to 14.1%. However, more than 50% recover after a period of 6–24 months after surgery and had an improved Frankel score, as compared to postoperative status. Tumor size of ependymoma does not affect resection rate or recurrence.
Conclusion: There is a considerable surgery-related morbidity for spinal ependymomas. However, depending on biologic grade and anatomic location, a substantial neurological improvement in further postoperative course may be achieved.