INTRAMEDULLARY EPENDYMOMAS: LONG-TERM RESULTS OF SURGICAL TREATMENT

Objective. To study the long-term results of surgical treatment of intramedullary ependymomas.

Material and Methods. Spinal ependymomas were detected in 91 (20.2 %) cases of a total number of operated patients. Intramedullary location of the tumor was diagnosed in 41 (45.0 %) patients. Ependymoma was benign in 78.1 % of cases and anaplastic in 9 cases (21.9 %). Radical removal of the tumor was achieved in 36 (87.8 %) patients, subtotal resection was performed in 5 cases (12.2 %).

Results. Gross neurological symptoms persisted in the long-term period in 6 (24.0 %) patients. Structural changes in the spine associated with surgical intervention was found only in 12.0 % of cases, relapses and continued growth of the tumor - in 16.1 %. Early postoperative mortality was 4.8 % (2 patients out of 41 died). In the late postoperative period, four more patients died, so that the overall mortality was 14.6 %. Five-year survival rate of patients corresponded to 80.6 %.

Conclusion. Radical surgery is an effective treatment for intramedullary ependymomas. The prognosis of intramedullary ependymoma may be considered as favorable in case of radical removal of the tumor, its benign nature, and good functional outcome of surgical treatment. 

1. Евзиков Г.Ю. Внутримозговые спинальные опухоли (клиника, диагностика, хирургическое лечение) // Нейрохирургия. 2004. № 1. С. 5-9.

2. Евзиков Г.Ю., Крылов В.В., Яхно Н.Н. Хирургическое лечение внутримозговых спинальных опухолей. М., 2006.

3. Кушель Ю.В. Роль ламинотомии и ламинопластики в снижении частоты послеоперационных кифосколиозов у детей, оперированных по поводу интрамедуллярных опухолей // Вопросы нейрохирургии им. Н.Н. Бурденко. 2007. № 4. С. 20-24.

4. Кушель Ю.В. Интрамедуллярные опухоли спинного мозга. Часть I. (эпидемиология, диагностика, принципы лечения) // Нейрохирургия. 2008. № 3. С. 9-17.

5. Цивьян Я.Л. Болезни ламинэктомированного позвоночника (методические указания). Новосибирск, 1976.

6. Харитонова К.И., Окладников Г.И. Патогенез и диагностика опухолей спинного мозга. Новосибирск, 1987.

7. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005; 114: 29-36. doi: 10.1016/j.pain.2004.12.010.

8. Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ. Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg. 2000; 93(2 Suppl): 183-193.

9. Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. SCIM - spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord. 1997; 35: 850-856.

10. Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, Hitzig SL, Glaser E, Zeilig G, Aito S, Scivoletto G, Mecci M, Chadwick RJ, El Masry WS, Osman A, Glass CA, Silva P, Soni BM, Gardner BP, Savic G, Bergström EM, Bluvshtein V, Ronen J, Catz A. The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil 2007; 29: 1926-1933. doi: 10.1080/09638280601046302.

11. Fisher G, Brotchi J. Intramedullary Spinal Cord Tumors. Stuttgart; New York: Thieme, 1996.

12. Fekete C, Eriks-Hoogland I, Baumberger M, Catz A, Itzkovich M, Luthi H, Post MW, von Elm E, Wyss A, Brinkhof MW. Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III). Spinal Cord. 2013; 51: 40-47. doi: 10.1038/sc.2012.87.

13. Gregorios JB, Green B, Page L, Thomsen S, Monforte H. Spinal cord tumors presenting with neural tube defects. Neurosurgery. 1986; 19: 962-966.

14. Lynch J, Kelly N, Fitzpatrick B, Regan P. A sacrococcygeal extraspinal ependymoma in a 67-year-old man: a case report and review of the literature. Br J Plast Surg. 2002; 55: 80-82. doi: 10.1054/bjps.2001.3724.

15. McCormick PC, Stein BM. Spinal cord tumors in adults. In: Youmans J, ed. Neurological Surgery. 4th ed. Philadelphia, PA: WB Saunders; 2003: 3102.

16. McCormick PC, Torres R, Post KD, Stein BM. Intramedullary ependymoma of the spinal cord. J Neurosurg. 1990; 72: 523-532.

17. Morantz RA. Ectopic ependymoma of the sacrococcygeal region. In: Doty JR, Rengachary SS, eds. Surgical Disorders of the Sacrum. New York: Thieme Medical Publishers, 1992: 177-179.