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

Abstract

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.

Surgical outcome and prognostic factors in spinal cord ependymoma: a single-center, long-term follow-up study

“…In our series as well as in others, the preoperative neurological status bears an increased risk of poor neurological outcome. 6 , 7 , 18 , 20 , 36 , 37 Preoperative neurological deficit reflects the damage of the spinal cord caused by the tumor, and the operative procedure increases this damage. In addition, regeneration of the neurological function is limited, especially if the preoperative poor neurological status persists over a longer time.…”

Long-term Neurologic Outcome After Spinal Ependymoma Resection With Multimodal Intraoperative Electrophysiological Recording: Cohort Study and Review of the Literature

“…Although conservative management may be a viable option for some patients [ 15 ], surgical resection remains the mainstay of SE treatment [ 16 , 17 ]. Despite the relatively fair prognosis for SE, poor outcomes have been shown to be associated with preoperative neurologic deficits, multisegmental disease, older age, thoracic tumor location, higher tumor grade, and STR [ 3 , 14 , 18 - 20 ].…”