Regional Spinal Cord Atrophy Is Associated with Poor Outcome After Surgery on Intramedullary Spinal Cord Ependymoma: A New Aspect of Delayed Neurological Deterioration

BACKGROUND: A considerable number of patients suffer delayed neurologic deficits, even after a successful removal of intramedullary spinal cord ependymoma. The underlying pathology remains unknown. Radiologic findings could provide an explanation for poor outcome after surgery. METHODS: We conducted a retrospective study of all cases treated from 1980 to 2016 in our department. The cohort included all patients with intramedullary spinal cord ependymoma treated with microsurgical excision. The cross-sectional area of the spinal cord at the level of the former performed surgery was compared using magnetic resonance imaging (MRI), follow-up MRI, adjacent unaffected levels, and the control group. RESULTS: Fifty-four patients with an intramedullary spinal cord lesion were treated in this period. Ependymoma was the predominant tumor (n = 28) followed by intramedullary gliomas and vascular lesions. Mean age (+/- SD) was 48.2 +/- 10.5 years with a female predominance (16 women, 12 men). An unfavorable outcome was observed in 53% of the patients after an initially uneventful postoperative course. The follow-up cross-sectional area of the spinal cord was significantly reduced in these patients compared to adjacent unoperated levels and the control group. Sagittal and axial spinal MRI showed spinal cord narrowing owing 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). CONCLUSIONS: Spinal cord atrophy seems to be a predicting factor in long-term outcome after surgical removal of intramedullary spinal cord ependymoma.