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Spinal Cord Ependymoma: Radical Surgical Resection and Outcome

Hanbali, Fadi M.D.; Fourney, Daryl R. M.D.; Marmor, Eric M.D.; Suki, Dima Ph.D.; Rhines, Laurence D. M.D.; Weinberg, Jeffrey S. M.D.; McCutcheon, Ian E. M.D.; Suk, Ian B.Sc., B.M.C.; Gokaslan, Ziya L. M.D.

Clinical Studies

OBJECTIVE : Several authors have noted increased neurological deficits and worsening dysesthesia in the postoperative period in patients with spinal cord ependymoma. We describe the neurological progression and pain evolution of these patients over the 1-year period after surgery. In addition, our favored method of en bloc tumor resection is illustrated, and the rate of complications, recurrence, and survival in this group of patients is addressed.

METHODS : We operated on 26 patients (12 male and 14 female) with low-grade spinal cord ependymomas between 1975 and 2001. The median age at diagnosis was 42 years. Tumors extended into the cervical cord in 13 patients, the thoracic cord in 7 patients, and the conus medullaris in 6 patients. Eleven patients had previous surgery and/or radiation therapy.

RESULTS : We achieved a gross total resection in 88% of patients, whereas 8% had a subtotal resection and 4% had a biopsy. Only 1 patient developed a recurrence over a mean follow-up period of 31 months.

CONCLUSION : We conclude that radical surgical resection of spinal cord ependymomas can be safely achieved in the majority of patients. A trend toward neurological improvement from a postoperative deficit can be expected between 1 and 3 months after surgery and continues up to 1 year. Postoperative dysesthesias begin to improve within 1 month of surgery and are significantly better by 1 year after surgery. The best predictor of outcome is the preoperative neurological status.

Department of Neurosurgery, University of Texas Medical Branch at Galveston, Galveston, Texas

Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas

Department of Neurology and Neurosurgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada

Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas

Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas

Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas

Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas

Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas

Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas

Reprint requests:

Ziya L. Gokaslan, M.D., Department of Neurosurgery, Johns Hopkins University, 600 N. Wolfe Street, Meyer 7-109, Baltimore, MD 21287.

Email: zgokasl1@jhmi.edu

Received, February 11, 2002.

Accepted, July 8, 2002.

Copyright © by the Congress of Neurological Surgeons