Surgical Management of Spinal Ependymoma

Intradural Tumors of the spinal cord account for 5% to 10% of all primary central nervous systemtumors. Spinal ependymoma is the most common intradural spinal tumor representing approximately 2% of all central nervous system tumors. Objectives: This study aimed to evaluate the Functional outcome of surgical management of spinal ependymoma either by total or subtotal tumor resection followed by radiotherapy. Patients and Methods: This prospective study included 19 adult patients; 13 males and 6 females, the mean age was 38.4 years. Operated upon in Neurosurgery Department, Cairo university hospitals from 2011 to 2013. Preoperative symptoms were pain and/or dysesthesias, numbness, progressive weakness and urinary or sexual symptoms with an average duration of 20 month. All patients underwent surgery for spinal ependymal tumors either by total or subtotal tumor resection followed by radiotherapy. Results: Total tumor resection was done in 15 patient (78.9 %) and subtotal resection in 4 cases (21.1%) who received postoperative radiotherapy. Clinical follow up being assessed by the McCormick scale which showed that preoperatively 8 patients were in grade I, 7 patients in grade II, 3 patients in grade III and one patient in grade IV. Directly postoperative, 9 patients became in grade I and 6 patient in grade II, 2 patients in grade III and 2 patients in grade IV (P = 0.3104). Patients who showed immediate worsening in the McCormick grading experienced improvement in the grade among 6 month follow up after surgery apart from one patient showed permanent worsening. At last follow-up after 18 month postoperatively, 14 patients were in grade I, 1 were in grade II, 2 patients remained in grade III and 2 patients remained in grade IV (P = 0.2207). Patients improved or been stable in McCormick grades after surgery was 14 from 19 patients (73.7%) and one case showed permanent worsening (5.3%) in the grade. Patients received tumor resection either by total or subtotal resection followed by radiotherapy showed overall improvement in the functional outcome after surgery. Conclusions: Favorable outcome can be achieved after surgical treatment of spinal Ependymoma. Total tumor resection if feasible should be considered as the ideal treatment of spinal Ependymoma to avoid hazards of subtotal resection followed by radiotherapy which may result in less favorable outcome and potential recurrence rate on long term follow up.