Surgery for Spinal Cord Ependymomas: Outcome and Prognostic Factors

被引:97
|
作者
Bostroem, Azize [1 ]
von Lehe, Marec [1 ]
Hartmann, Wolfgang [2 ]
Pietsch, Torsten [2 ]
Feuss, Mareike [1 ]
Bostroem, Jan P. [1 ]
Schramm, Johannes [1 ]
Simon, Matthias [1 ]
机构
[1] Univ Hosp Bonn, Dept Neurosurg, Med Ctr, D-53105 Bonn, Germany
[2] Univ Hosp Bonn, Dept Neuropathol, Med Ctr, D-53105 Bonn, Germany
关键词
McCormick grade; Microsurgery; Myxopapillary ependymoma; Spinal ependymoma; POSTOPERATIVE RADIATION; SURGICAL RESECTION; MANAGEMENT; RADIOTHERAPY; PREDICTORS;
D O I
10.1227/NEU.0b013e3182004c1e
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Spinal cord tumors account for 5% to 10% of all primary central nervous system tumors. The most common intramedullary neoplasms are ependymomas, composing 50% to 60% of spinal neuroepithelial tumors in adults. OBJECTIVE: To evaluate the clinical and oncological outcomes of patients with spinal ependymoma primarily treated with microsurgery. METHODS: Patient charts and operative notes were analyzed to evaluate the clinical and oncological outcomes of 57 patients (33 men, 24 women) undergoing surgery for spinal ependymal tumors between 1987 and 2007. Mean follow-up was 67 months (range, 1-195 months; median, 56 months). Histopathological findings were 1 subependymoma World Health Organization (WHO) grade I, 16 myxopapillary ependymomas WHO grade I, 39 ependymomas WHO grade II, and 1 anaplastic ependymoma WHO grade III. Histopathological diagnoses were reviewed in 52 cases (91%) using the 2007 WHO classification. RESULTS: There were 47 complete resections (83%). Only 4 patients (7%) underwent (postoperative) radiotherapy. Forty-nine of 57 patients (86%) had stable or improved McCormick grades directly after surgery. A permanent decrease in the McCormick grade was seen in 4 (7%) patients. Multivariate logistic regression revealed only the preoperative neurological status of the patient as an independent predictor of functional outcome (P = .007). Recurrent tumors were diagnosed 12 to 72 months after surgery in 5 of 57 patients (9%) including 3 of 16 myxopapillary ependymomas (19%). In 4 of 5 patients, the primary tumor was incompletely resected. The progression-free survival rate was 89% and 84% for all patients at 5 and 10 years, respectively. An incomplete resection proved the only independent predictor of progression-free survival (P = .05). CONCLUSION: These results support early surgery aiming at complete resection as the primary treatment for presumed spinal ependymomas. The prognosis after surgery for some myxopapillary ependymomas seems worse than generally believed.
引用
收藏
页码:302 / 309
页数:8
相关论文
共 50 条
  • [21] Exophytic ependymomas of the spinal cord - Comment
    Helseth, E
    ACTA NEUROCHIRURGICA, 2004, 146 (09) : 1050 - 1050
  • [22] Malignant Epidural Spinal Cord Compression: Prognostic Factors Predicting Need for Surgery
    Conrad, T. D.
    Wang, L.
    Bezjak, A.
    Levin, W.
    Dawson, L.
    Fehlings, M.
    Raja, R.
    Rebecca, W.
    INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2014, 90 : S593 - S593
  • [23] ADULT INTRAMEDULLARY SPINAL-CORD EPENDYMOMAS - THE RESULT OF SURGERY IN 38 PATIENTS
    EPSTEIN, FJ
    FARMER, JP
    FREED, D
    JOURNAL OF NEUROSURGERY, 1993, 79 (02) : 204 - 209
  • [24] INTRACRANIAL EPENDYMOMAS OF CHILDHOOD - LONG-TERM OUTCOME AND PROGNOSTIC FACTORS
    POLLACK, IF
    GERSZTEN, PC
    MARTINEZ, AJ
    LO, KH
    SHULTZ, B
    ALBRIGHT, AL
    JANOSKY, J
    DEUTSCH, M
    NEUROSURGERY, 1995, 37 (04) : 655 - 666
  • [25] INTRACRANIAL EPENDYMOMAS OF CHILDHOOD - LONG-TERM OUTCOME AND PROGNOSTIC FACTORS
    POLLACK, IF
    GERSZTEN, P
    MARTINEZ, AJ
    JOURNAL OF NEUROSURGERY, 1995, 82 (02) : A351 - A352
  • [26] Symptomatic factors and timing of surgery affecting outcome for lumbosacral spinal cord tethering
    Tseng, JH
    Tseng, MY
    JOURNAL OF NEUROSURGERY, 2006, 104 (04) : A643 - A643
  • [27] Prognostic Factors in Supratentorial Ependymomas
    Alexiou, George A.
    Stefanaki, Kalliopi
    Prodromou, Neofytos
    PEDIATRIC NEUROSURGERY, 2013, 49 (02) : 129 - 129
  • [28] PROGNOSTIC FACTORS IN CHILDHOOD EPENDYMOMAS
    SUTTON, LN
    GOLDWEIN, J
    PERILONGO, G
    LANG, B
    SCHUT, L
    RORKE, L
    PACKER, R
    PEDIATRIC NEUROSURGERY, 1991, 16 (02) : 57 - 65
  • [29] PROGNOSTIC FACTORS IN INFANTS WITH EPENDYMOMAS
    DUFFNER, PK
    COHEN, ME
    KUN, L
    KRISCHER, J
    SANFORD, R
    BURGER, P
    HOROWITZ, M
    FRIEDMAN, H
    ANNALS OF NEUROLOGY, 1995, 38 (03) : 546 - 546
  • [30] Surgery for metastatic spinal differentiated thyroid cancer: feasibility, outcome, and prognostic factors
    Liu, Xiajun
    Hu, Panpan
    Zhai, Shuheng
    Liu, Xiao
    Wang, Ben
    Zhou, Hua
    Liu, Xiaoguang
    Liu, Zhongjun
    Wei, Feng
    FRONTIERS IN SURGERY, 2023, 10