Clinical characteristics and surgical outcomes of ependymomas in the upper cervical spinal cord: a single-center experience of 155 consecutive patients

Fei, Xiaobin; Jia, Wenqing; Gao, Heng; Yang, Chenlong; Li, Da; Qian, Zenghui; Han, Bo; Wang, Dejiang; Xu, Yulun

doi:10.1007/s10143-020-01363-7

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…This is consistent with several publications [12,13]. In accordance with our findings and previously conducted studies [10] observing a solid correlation of postoperative neurological decrease with the extent of preoperative disability, we recommend early surgery when patients' neurological deficits are mild. As observed in our study, only a small proportion of patients improved their functional status compared with the status before surgery (5.7% in our series).…”

Section: Prognostic Factors For Neurologic Deteriorationsupporting

confidence: 93%

“…There is current evidence that the cervical location is an adverse predictive factor for functional outcomes after the surgery of IMSCT. In a large retrospective study reporting on ependymomas of the upper cervical spinal cord, Fei et al reported on postoperative neurological impairment in 76% of patients and observed a subsequent slow recovery during the next 56 months, still rendering 21% of patients with permanent deterioration [10]. A similar trend of the preoperative, early, and late postoperative neurological status of their patients was reported by another series of intramedullary ependymomas, with a significant deterioration in McCormick scale in the early postoperative period and a recovery to the preoperative condition at the follow-up [11].…”

Section: Clinical Outcomementioning

confidence: 99%

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Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine

Goloshchapova,

Goldberg,

Meyer

et al. 2023

Medicina

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Background and Objectives: Intramedullary spinal cord tumors (IMSCT) are rare entities. A location in the upper cervical spine as a highly eloquent region carries the risk of postoperative neurological deficits, such as tetraparesis or respiratory dysfunction. Evidence for respiratory dysfunction is scarce. This study aimed to describe these highly eloquent tumors’ early and late postoperative clinical course. Materials and Methods: This is a single-center retrospective cohort study. We included 35 patients with IMSCT at levels of the craniocervical junction to C4 who underwent surgical treatment between 2008 and 2022. The authors analyzed the patients’ preoperative status, tumor- and surgery-specific characteristics, and follow-up functional status. Results: The study cohort included twenty-two patients with grade II ependymoma (62.9%), two low-grade astrocytomas (5.7%), two glioblastomas (5.7%), six hemangioblastomas (17.1%), two metastases (5.7%), and one patient with partially intramedullary schwannoma (2.9%). Gross total resection was achieved in 76% of patients. Early dorsal column-related symptoms (gait ataxia and sensory loss) and motor deterioration occurred in 64% and 44% of patients. At a follow-up of 3.27 ± 3.83 years, 43% and 33% of patients still exhibited postoperative sensory and motor deterioration, respectively. The median McCormick Scale grade was 2 in the preoperative and late postoperative periods, respectively. Only three patients (8.6%) developed respiratory dysfunction, of whom, two patients, both with malignant IMSCT, required prolonged invasive ventilation. Conclusions: More than 60% of the patients with IMSCT in the upper cervical cord developed new neurological deficits in the immediate postoperative period, and more than 40% are permanent. However, these deficits are not disabling in most cases since most patients maintain functional independence as observed by unchanged low McCormick scores. The rate of respiratory insufficiency is relatively low and seems to be influenced by the rapid neurological deterioration in high-grade tumors.

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Section: Prognostic Factors For Neurologic Deteriorationsupporting

confidence: 93%

Section: Clinical Outcomementioning

confidence: 99%

Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine

Goloshchapova,

Goldberg,

Meyer

et al. 2023

Medicina

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“…A German team led by Behmanesh proposed that regional spinal cord atrophy was associated with poor long-term outcome after surgical removal of intramedullary spinal cord ependymoma [4]. Fei et al postulated the tumor-to-cord ratio might be a predictor for the surgical outcome of upper cervical ependymomas, while the logistic regression analysis yielded a negative result [8]. Arima and coworkers found that quantitative analysis of near-infrared indocyanine green angiography could predict functional outcomes after spinal ependymoma removal [2].…”

Section: Discussionmentioning

confidence: 99%

“…Due to the small sample size in the incomplete resection cohort, we failed to analyze the correlation between the extent of surgical resection and functional outcomes. Some scholars found permanent de cits after the spinal ependymoma resection was independently predicted by older age [3,8,27]. Bansal et al followed up 146 patients with spinal intramedullary tumors; they found that the surgical outcome at the last follow-up was correlated with age, sex, the preoperative functional status, tumor size, location, pathology, the extent of surgical resection, and the presence of syringomyelia [3].…”

Section: Discussionmentioning

confidence: 99%

Multisegmental versus monosegmental intramedullary spinal cord ependymomas: perioperative neurological functions and surgical outcomes

et al. 2021

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Objectives: Multiple factors, such as tumor size, lateralization, tumor location, accompanying syringomyelia, and regional spinal cord atrophy, may affect the resectability and clinical prognosis of intramedullary spinal cord ependymomas. However, whether longsegmental involvement of the spinal cord may impair functional outcomes remains unclear. This study was aimed to compare perioperative neurological functions and long-term surgical outcomes between multisegmental ependymomas and their monosegmental counterparts.Methods: A total of 54 patients with intramedullary spinal cord ependymoma (WHO Grade II) were enrolled, and all of them underwent surgical resection. The patients were classi ed into the multisegmental group (n=40) and the monosegmental group (n=14). Perioperative and long-term (average follow-up period, 53.5 ± 18.2 months) neurological functions were evaluated using the modi ed McCormick (mMC) scale and the modi ed Japanese Orthopaedic Association (mJOA) scoring system.Results: Preoperative neurological functions in the multisegmental group were signi cantly worse than those in the monosegmental group (P < 0.05). However, postoperative short-term neurological functions, as well as long-term functional outcomes, were similar between the two groups (P > 0.05). Logistic regression analysis showed that only preoperative mMC and mJOA scores were signi cantly correlated with neurological improvement during the follow-up period (P < 0.05). Conclusion:Multisegmental involvement of the spinal cord is associated with worse neurological functions in patients with intramedullary spinal cord ependymoma, while the long-term prognosis is not affected. The preoperative neurological status of the patient is the only predictor of long-term functional improvement.

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“…Early symptoms are variable and may only subtly progress; their appearance before diagnosis is often in the three- to four-year range, although intratumoral hemorrhage may trigger an abrupt decline [ 25 , 26 ]. Symptoms and deficits are related to the specific location and extent of the tumor.…”

Section: Reviewmentioning

confidence: 99%

Spinal Ependymomas: An Updated WHO Classification and a Narrative Review

Villanueva-Castro,

Meraz-Soto,

Hernández-Dehesa

et al. 2023

Cureus

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Ependymomas are neuroepithelial tumors that develop from ependymal cells found in the brain parenchyma and can spread to any part of the spinal cord. Three to six percent of all malignancies affecting the central nervous system (CNS) are ependymomas. Even the most talented surgeons are challenged by spinal cord ependymomas; as a result, research into this clinical phenomenon should continue. Since 1979, the World Health Organization (WHO) has published a classification and grading system for CNS malignancies to ensure consistent diagnostic standards worldwide. The WHO prepared an update on these tumors, paying particular attention to molecular techniques to categorize the therapeutic management of each patient with greater accuracy and clarity. We thoroughly reviewed the literature on the epidemiology, etiology, diagnosis, and treatment of spinal ependymomas since there has not been a recent review of these tumors. This included modifications to the 2021 WHO Classification of Tumors of the Central Nervous System.

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Clinical characteristics and surgical outcomes of ependymomas in the upper cervical spinal cord: a single-center experience of 155 consecutive patients

Cited by 8 publications

References 25 publications

Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine

Neurological Outcome and Respiratory Insufficiency in Intramedullary Tumors of the Upper Cervical Spine

Multisegmental versus monosegmental intramedullary spinal cord ependymomas: perioperative neurological functions and surgical outcomes

Spinal Ependymomas: An Updated WHO Classification and a Narrative Review

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