Management and outcome analysis of conus and filum ependymoma: A tertiary center study

Manoharan Sudhan; Guru Satyarthee; Leve Joseph; Mehar Sharma; Aanchal Kakkar; Bhawani Sharma

doi:10.4103/ajns.AJNS_326_16

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(03): 821-827
DOI: 10.4103/ajns.AJNS_326_16

Original Article

Management and outcome analysis of conus and filum ependymoma: A tertiary center study

Manoharan Sudhan

Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi

,

Guru Satyarthee

Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi

,

Leve Joseph

¹Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi

,

Mehar Sharma

²Department of Neuropathology, All India Institute of Medical Sciences, New Delhi

,

Aanchal Kakkar

²Department of Neuropathology, All India Institute of Medical Sciences, New Delhi

,

Bhawani Sharma

Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi

› Institutsangaben

Abstract

Background: Spinal ependymomas constitute approximately 2%–8% of primary adult central nervous system tumors. Authors analyzed demographic, clinical, radiological, surgical, and histopathological factors which correlated with the postoperative neurological outcome of patients who underwent surgery for conus and filum ependymoma (CFE). Materials and Methods: A retrospective analysis of 31 patients regarding clinical feature, imaging study, surgical management, and McCormick grading system for assessing functional neurological status was carried out, who underwent surgical management for CFE between January 2009 and April 2014. Final neurological outcome at follow-up period was correlated with various factors in search to find out probable prognostic factors affecting final neurological outcome following surgical management. Results: The myxopapillary ependymoma was observed in 55% of cases (n = 17), while 39% cases (n = 12) had Grade II ependymoma and rest 6% (n = 2) cases had anaplastic ependymomas. The mean age was 30 years (range 7–60 years) with male to female ratio of 1:0.82. Patients predominantly presented with pain (80.65%); mean duration of symptoms was 28.61 months. Only, the preoperative McCormick grade was found to be the statistically significant prognostic factor (P = 0.045), affecting neurological outcome however, the age, sex, duration of symptoms, location of the tumor, extent of the tumor, extradural spread, degree of surgical excision, vascularity of tumor, and histopathological World Health Organization grades were not found to be significant prognostic factors in the current study. Conclusion: The preoperative McCormick score was found to be the only statistically significant factor predicting the functional and neurological outcome after surgery, so surgical treatment should be offered early in the course of the disease to provide chance of preservation and good neurological recovery.

Key-words:

Conus medullaris - filum terminale - intradural lesion - myxopapillary ependymoma - postoperative neurological outcome - prognostic factors

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Referenzen

References
1 Chamberlain MC, Tredway TL. Adult primary intradural spinal cord tumors: A review. Curr Neurol Neurosci Rep 2011;11:320-8.
2 Central Brain Tumor Registry of the United States (CBTRUS). CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2004-2006. Hinsdale, IL: CBTRUS; 2010.
3 Fassett DR, Schmidt MH. Lumbosacral ependymomas: A review of the management of intradural and extradural tumors. Neurosurg Focus 2003;15:E13.
4 Poppleton H, Gilbertson RJ. Stem cells of ependymoma. Br J Cancer 2007;96:6-10.
5 Duffau H, Gazzaz M, Kujas M, Fohanno D. Primary intradural extramedullary ependymoma: Case report and review of the literature. Spine (Phila Pa 1976) 2000;25:1993-5.
6 Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114:97-109.
7 Sonneland PR, Scheithauer BW, Onofrio BM. Myxopapillary ependymoma. A clinicopathologic and immunocytochemical study of 77 cases. Cancer 1985;56:883-93.
8 Celli P, Cervoni L, Cantore G. Ependymoma of the filum terminale: Treatment and prognostic factors in a series of 28 cases. Acta Neurochir (Wien) 1993;124:99-103.
9 Halvorsen CM, Kolstad F, Hald J, Johannesen TB, Krossnes BK, Langmoen IA, et al. Long-term outcome after resection of intraspinal ependymomas: Report of 86 consecutive cases. Neurosurgery 2010;67:1622-31.
10 Boström A, von Lehe M, Hartmann W, Pietsch T, Feuss M, Boström JP, et al. Surgery for spinal cord ependymomas: Outcome and prognostic factors. Neurosurgery 2011;68:302-9.
11 Nakamura M, Ishii K, Watanabe K, Tsuji T, Matsumoto M, Toyama Y, et al. Long-term surgical outcomes for myxopapillary ependymomas of the cauda equina. Spine (Phila Pa 1976) 2009;34:E756-60.
12 Schweitzer JS, Batzdorf U. Ependymoma of the cauda equina region: Diagnosis, treatment, and outcome in 15 patients. Neurosurgery 1992;30:202-7.
13 Armstrong TS, Vera-Bolanos E, Gilbert MR. Clinical course of adult patients with ependymoma: Results of the Adult Ependymoma Outcomes Project. Cancer 2011;117:5133-41.
14 Mork SJ, Loken AC. Ependymoma: A follow-up study of 101 cases. Cancer 1977;40:907-15.
15 McCormick PC, Torres R, Post KD, Stein BM. Intramedullary ependymoma of the spinal cord. J Neurosurg 1990;72:523-32.
16 de Jong L, Calenbergh FV, Menten J, van Loon J, De Vleeschouwer S, Plets C, et al. Ependymomas of the filum terminale: The role of surgery and radiotherapy. Surg Neurol Int 2012;3:76.
17 Kucia EJ, Maughan PH, Kakarla UK, Bambakidis NC, Spetzler RF. Surgical technique and outcomes in the treatment of spinal cord ependymomas: Part II: Myxopapillary ependymoma. Neurosurgery 2011;68 1 Suppl Operative: 90-4.
18 Plans G, Brell M, Cabiol J, Villà S, Torres A, Acebes JJ. Intracranial retrograde dissemination in filum terminale myxopapillary ependymomas. Acta Neurochir (Wien) 2006;148:343-6.
19 Pica A, Miller R, Villà S, Kadish SP, Anacak Y, Abusaris H, et al. The results of surgery, with or without radiotherapy, for primary spinal myxopapillary ependymoma: A retrospective study from the rare cancer network. Int J Radiat Oncol Biol Phys 2009;74:1114-20.
20 Chao ST, Kobayashi T, Benzel E, Reddy CA, Stevens GH, Prayson RA, et al. The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas. J Neurosurg Spine 2011;14:59-64.
21 Oh MC, Ivan ME, Sun MZ, Kaur G, Safaee M, Kim JM, et al. Adjuvant radiotherapy delays recurrence following subtotal resection of spinal cord ependymomas. Neuro Oncol 2013;15:208-15.
22 Lee SH, Chung CK, Kim CH, Yoon SH, Hyun SJ, Kim KJ, et al. Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: A retrospective multicenter study by the Korea Spinal Oncology Research Group. Neuro Oncol 2013;15:921-9.
23 Chamberlain MC. Salvage chemotherapy for recurrent spinal cord ependymona. Cancer 2002;95:997-1002.
24 Bagley CA, Wilson S, Kothbauer KF, Bookland MJ, Epstein F, Jallo GI. Long term outcomes following surgical resection of myxopapillary ependymomas. Neurosurg Rev 2009;32:321-34.
25 Rezai AR, Woo HH, Lee M, Cohen H, Zagzag D, Epstein FJ. Disseminated ependymomas of the central nervous system. J Neurosurg 1996;85:618-24.
26 Nagasawa DT, Smith ZA, Cremer N, Fong C, Lu DC, Yang I. Complications associated with the treatment for spinal ependymomas. Neurosurg Focus 2011;31:E13.
27 Waldron JN, Laperriere NJ, Jaakkimainen L, Simpson WJ, Payne D, Milosevic M, et al. Spinal cord ependymomas: A retrospective analysis of 59 cases. Int J Radiat Oncol Biol Phys 1993;27:223-9.
28 Tarapore PE, Modera P, Naujokas A, Oh MC, Amin B, Tihan T, et al. Pathology of spinal ependymomas: An institutional experience over 25 years in 134 patients. Neurosurgery 2013;73:247-55.
29 Oh MC, Tarapore PE, Kim JM, Sun MZ, Safaee M, Kaur G, et al. Spinal ependymomas: Benefits of extent of resection for different histological grades. J Clin Neurosci 2013;20:1390-7.