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Microsurgical Treatment for Intramedullary Spinal Cord Ependymomas: Radical Surgical Resection and Outcome

Azzazi, Alaa MD; Sakr, Sameh MD; Sedik, Mohamed MD

doi: 10.1097/WNQ.0b013e31820cae77
Original Articles
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Objectives To evaluate the feasibility and outcome of en-block surgical resection of spinal cord ependymomas and to determine the frequency of the need for radiotherapy as adjuvant therapy

Patients and Methods The study included 17 patients with spinal cord ependymomas; 7 men and 10 women with mean age of 37.2±11.7 years. Patients presented with pain, sensory disturbances, and motor dysfunction with a mean duration of symptoms of 12.4±8.4 months. McCormick clinical grading defined 3 grade I patients, 7 grade II patients, 5 grade III patients, and 2 grade IV patients. Preoperative magnetic resonance imagining showed well-demarcated intramedullary lesions with a median length of 2 vertebral bodies. Eight patients had cervical lesions, 2 patients had cervicothoracic and 2 patients had thoracic lesions, and 5 patients had conus medullaris lesions. All patients had surgical resection using the microsurgical technique through posterior approach and the excised specimens were sent for pathological examination. Postoperative magnetic resonance imagining evaluating residual tumors and clinical grading were performed.

Results Gross total resection could be achieved in 10 patients (58.8%), subtotal in 5 patients (29.4%), and biopsy in 2 patients (11.8%). Clinical grading determined immediately and 3 months postoperative were significantly superior to preoperative grading. Histopathological examination of excised specimens showed low-grade ependymoma. Four patients underwent radiotherapy after surgery. No change of clinical grading was reported in 5 patients (3 were grade I and 2 were grade IV) and 7 patients, 6 grade II and 1 grade III showed improvement to grade I. However, 5 patients, 4 grade III and 1 grade II showed immediate postoperative deterioration to grades IV and III, respectively, but at 3 months after surgery, 4 patients were improved, 3 to grade III and 1 to grade II. At the end of the follow up, 10 patients (58.8%) had stabilized and 7 patients (41.2%) had improved neurological status with no permanent deterioration and no recurrence for totally resected lesions was detected and no disease or surgery-related mortality was reported.

Conclusions Total-subtotal resection of intramedullary ependymomas using the microsurgical technique is a feasible and safe management policy without causing permanent neurological deficits and transient immediate postoperative neurological deterioration showed improvement within 3 months. The site and the degree of infiltration of the lesion manifested as preoperative neurological status are important determinants for the outcome.

Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Kasr El Eini, Egypt

Reprints: Alaa Azzazi, MD, Department of Neurosurgery, Cairo University, 106 Gameat Eldowal Street 12th Floor, Flat No. 6 Mohandesseen, Cairo, Egypt (e-mail: alaaazzazi@yahoo.com).

© 2011 Lippincott Williams & Wilkins, Inc.