Spinal Cord Ependymoma: Radical Surgical Resection and Outcome

Hanbali, Fadi; Fourney, Daryl R.; Marmor, Eric; Suki, Dima; Rhines, Laurence D.; Weinberg, Jeffrey S.; McCutcheon, Ian E.; Suk, Ian; Gokaslan, Ziya L.; Bristol, Ruth E.; Spetzler, Robert F.; Rekate, Harold L.; Ebersold, Michael J.; Brotchi, Jacques; McCormick, Paul C.

doi:10.1097/00006123-200211000-00010

Cited by 175 publications

(143 citation statements)

References 36 publications

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“…5,6 Ependymomas can usually be resected completely under a microscope; however, the rate of total resection in past reports has been approximately 70%. 5,6 In recent years, 4,7,8 however, the rate has improved to approximately 90%, as in the present report. These higher percentages appear to be attributable to advances in diagnostic imaging and improvements in the surgical techniques in recent years.…”

Section: Discussionsupporting

confidence: 72%

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Surgical treatment of intramedullary spinal cord tumors: prognosis and complications

et al. 2007

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Study design: Retrospective case series. Objective: To evaluate our recent treatment strategy for intramedullary spinal cord tumors. Setting: Department of Orthopaedic Surgery, Keio University, Japan. Methods: We reviewed 68 cases of intramedullary tumors (ependymoma, 33; astrocytoma, 23; hemangioblastoma, 12), treated surgically between 1994 and 2003. There were 42 males and 26 females whose mean age at the time of surgery was 43 years. The mean follow-up period was 6.2 years. The tumor malignancy grade according to the WHO classification was astrocytoma grade I, 3; grade II, 8 (low-grade: 11 cases); grade III, 10; grade IV, 2 (high-grade: 12 cases). All ependymomas were grade II. Three of the 12 hemangioblastomas were associated with von Hippel-Lindau disease. Results: Total excision was achieved in 90% of the ependymomas and functional improvement was obtained when the preoperative neurological deficit was mild. Approximately 50% of low-grade astrocytomas could be totally excised with favorable survival outcomes, suggesting that total excision should be attempted for low-grade astrocytomas. However, total excision of high-grade tumors was difficult and the functional outcomes were poor. Cordotomy should be considered in patients with a thoracic high-grade astrocytoma. Total resection was possible in 92% of hemangioblastoma, and the functional outcomes were good, however, more attention should be paid for tumors with feeding arteries on the ventral side and for those associated with von Hippel-Lindau disease. Conclusions: Predictors of good surgical outcome for intramedullary spinal cord tumors were histological grades of the tumors, surgical margins, and neurological status of the patient before surgery.

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Section: Discussionsupporting

confidence: 72%

“…The functional status of each patient was determined using the modified Frankel classification before surgery and at the time of the final examination. 4 …”

Section: Methodsmentioning

confidence: 99%

Surgical treatment of intramedullary spinal cord tumors: prognosis and complications

et al. 2007

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“…Previous single-institution series have almost exclusively focused on the description, prevention and management of neurologic complications. [8][9][10][11][12][13][14] Our study demonstrates the significant negative impact of mostly nonneurologic complications on patient outcomes. Therefore, avoidance, recognition and prompt management of neurologic as well as nonneurologic postoperative complications is extremely important in the successful surgical management of patients with spinal tumors.…”

Section: Discussionmentioning

confidence: 86%

“…Previous single-institution series have reported postoperative complication rates of 11-64% with generally higher complication rates after resection of astrocytomas compared to ependymomas. [8][9][10][11][12][13][14] The NIS data do not afford distinction between the different pathologic types of spinal cord tumors and hence, we cannot comment on the complication rates after resection of astrocytomas versus ependymomas. Furthermore, the 17.5% complication rate we report in our study is likely an underestimate of the true complication rate because only select complications were examined.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the limitation of the NIS dataset, other previously reported factors such as tumor pathology, grade, preoperative neurologic status and extent of tumor resection that predict outcome could not be evaluated in this analysis. 2,9,10,12 Also, this analysis contains only inpatient outcomes and cannot comment on long-term outcomes or recurrences. Nonetheless, this is the first study to report morbidity, mortality and the effect of postoperative complications on resource utilization on a national level for surgically treated spinal cord tumors.…”

Section: Discussionmentioning

confidence: 99%

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Complications and outcomes after spinal cord tumor resection in the United States from 1993 to 2002

Patil

Lad

et al. 2007

Spinal Cord

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Study design: Retrospective cohort study. Objective: Data on patient outcomes after surgery for spinal cord tumors have been derived from single-institution series. The objective of this study is to report inpatient complications, mortality and outcomes on a national level. Setting: United States, national inpatient care database. Methods: The National Inpatient Sample (NIS) was used to identify 19 017 admissions for resection of a spinal cord tumor in the United States from 1993 to 2002. The effects of patient and hospital characteristics on inpatient outcomes were analyzed using logistic regression. Results: The in-hospital mortality rate and the complication rate were 0.55 and 17.5%, respectively. Urinary and renal complications (3.7%), postoperative hemorrhages or hematomas (2.5%) and pulmonary complications (2.4%) were the most common complications reported. A single postoperative complication increased the length of stay by 4 days, increased the mortality rate by sixfold and added over $10 000 to hospital charges. Multivariate analysis showed that complications were more likely in African Americans and patients with multiple comorbidities. The odds of an adverse outcome increased significantly with age greater than 64, multiple comorbidities and postoperative complications. Conclusion: A national perspective on inpatient outcomes after resection of spinal cord tumors has been provided. The significant negative impact of postoperative complications on mortality and resource utilization has been demonstrated. We have identified advanced age and multiple comorbidities as risk factors that predict adverse outcome. Furthermore, this study highlights the importance of avoidance, recognition and prompt management of nonneurologic complications.

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