Spinal Ependymomas: An Updated WHO Classification and a Narrative Review

Abstract

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.

States of Arts and New Approaches to Spinal Cord Tumors

“…Ependymomas may exhibit heterogeneous enhancement with contrast due to the presence of cystic components. Schwannomas typically show intense, homogeneous enhancement following contrast administration [26].…”

“…These accompanying features may vary depending on the tumor type and location. Peritumoral cysts: Seen in ependymomas and hemangioblastomas [26,29]. Edema: Commonly observed around high-grade gliomas, such as glioblastomas [30].…”