Spinal Myxopapillary Ependymoma: The Sapienza University Experience and Comprehensive Literature Review Concerning the Clinical Course of 1602 Patients

Pesce, Alessandro; Palmieri, Mauro; Armocida, Daniele; Frati, Alessandro; Miscusi, Massimo; Raco, Antonino

doi:10.1016/j.wneu.2019.05.206

Cited by 26 publications

(13 citation statements)

References 48 publications

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“…Reviewing the literature, we found that the mean patient age at the time of tumor symptomatic occurrence was 36.44 years, and that medullary conus was involved in 28.4% of cases 17 , which was less consistent with our results where the mean patient age was 47.28 years and the entire medullary conus was involved in four out of seven (57.1%) patients.…”

Section: Discussioncontrasting

confidence: 77%

Myxopapillary Ependymoma of the Spinal Cord in Adults: a Report of Personal Series and Review of Literature

Omerhodžić

Pojskić

Rotim

et al. 2020

ACC

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-Myxopapillary ependymomas (MPE) of the spinal cord are slow-growing benign tumors most frequently found in adults between 30 and 50 years of age. They arise from the ependyma of the filum terminale and are located in the area of the medullary conus and cauda. The recommended treatment option is gross total resection, while patients undergoing subtotal resection usually require radiotherapy. Complete resection without capsular violation can be curative and is often accomplished by simple resection of the filum above and below the tumor mass. Nevertheless, dissemination and distant treatment failure may occur in approximately 30% of the cases. In this paper, we propose an original MPE classification, which is based upon our personal series report concerned with tumor location and its correlation with the extent of resection. We also provide literature review, discussing surgical technique, tumor recurrence rate and dissemination, and adjuvant treatment. In conclusion, our findings suggest that MPE management based on the proposed 5-type tumor classification is favorable when total surgical resection is performed in carefully selected patients. Yet, further studies on a much broader model is obligatory to confirm this.

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Section: Discussioncontrasting

confidence: 77%

Myxopapillary Ependymoma of the Spinal Cord in Adults: a Report of Personal Series and Review of Literature

Omerhodžić

Pojskić

Rotim

et al. 2020

ACC

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“…Resection is the primary management strategy for spinal MPE, and GTR is associated with significantly improved disease outcomes. 2,4,8 The frequency of GTR varies between 27% and 100% in the literature, and the data presented in our study demonstrate a clear benefit in terms of RFS with aggressive upfront GTR. 8 Of course, in general, no surgeon undertakes a deliberate STR when a GTR is feasible, and therefore, even a definitive conclusion regarding GTR versus STR is difficult to promulgate in such a retrospective series.…”

Section: Discussionsupporting

confidence: 62%

Analyzing the role of adjuvant or salvage radiotherapy for spinal myxopapillary ependymomas

Kotecha

Tom

Naik

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEThe authors sought to describe the long-term recurrence patterns, prognostic factors, and effect of adjuvant or salvage radiotherapy (RT) on treatment outcomes for patients with spinal myxopapillary ependymoma (MPE).METHODSThe authors reviewed a tertiary institution IRB-approved database and collected data regarding patient, tumor, and treatment characteristics for all patients treated consecutively from 1974 to 2015 for histologically confirmed spinal MPE. Key outcomes included relapse-free survival (RFS), postrecurrence RFS, failure patterns, and influence of timing of RT on recurrence patterns. Cox proportional hazards regression and Kaplan-Meier analyses were utilized.RESULTSOf the 59 patients included in the study, the median age at initial surgery was 34 years (range 12–74 years), 30 patients (51%) were female, and the most common presenting symptom was pain (n = 52, 88%). Extent of resection at diagnosis was gross-total resection (GTR) in 39 patients (66%), subtotal resection (STR) in 15 (25%), and unknown in 5 patients (9%). After surgery, 10 patients (17%) underwent adjuvant RT (5/39 GTR [13%] and 5/15 STR [33%] patients). Median follow-up was 6.2 years (range 0.1–35.3 years). Overall, 20 patients (34%) experienced recurrence (local, n = 15; distant, n = 5). The median RFS was 11.2 years (95% CI 77 to not reached), and the 5- and 10-year RFS rates were 72.3% (95% CI 59.4–86.3) and 54.0% (95% CI, 36.4–71.6), respectively.STR was associated with a higher risk of recurrence (HR 6.45, 95% CI 2.15–19.23, p < 0.001) than GTR, and the median RFS after GTR was 17.2 years versus 5.5 years after STR. Adjuvant RT was not associated with improved RFS, regardless of whether it was delivered after GTR or STR. Of the 20 patients with recurrence, 12 (60%) underwent salvage treatment with surgery alone (GTR, n = 6), 4 (20%) with RT alone, and 4 (20%) with surgery and RT. Compared to salvage surgery alone, salvage RT, with or without surgery, was associated with a significantly longer postrecurrence RFS (median 9.5 years vs 1.6 years; log-rank, p = 0.006).CONCLUSIONSAt initial diagnosis of spinal MPE, GTR is key to long-term RFS, with no benefit to immediate adjuvant RT observed in this series. RT at the time of recurrence, however, is associated with a significantly longer time to second disease recurrence. Surveillance imaging of the entire neuraxis remains crucial, as distant failure is not uncommon in this patient population.

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“…The early recognition of signs and symptoms, that allows diagnosis of early-stage disease before spinal cord damage occurs, can reduce the risk of postoperative morbidity and may improve surgical outcome (29)(30)(31). A strong correlation has been suggested between the degree of functional impairment and the extent of damage to the spinal cord or spinal roots: the greater the impairment, the longer the persistence of the lesion, and the more difficult postoperative functional recovery will be, despite radical tumor removal (32)(33)(34)(35). In this regard, the present study confirmed previous results of the literature.…”

Section: Discussionmentioning

confidence: 99%

Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience

et al. 2020

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Objective: Intradural Extramedullary (IDEM) tumors are usually treated with surgical excision. The aim of this study was to investigate the impact on clinical outcomes of pre-surgical clinical conditions, intraoperative neurophysiological monitoring (IONM), surgical access to the spinal canal, histology, degree of resection and intra/postoperative complications.Methods: This is a retrospective observational study analyzing data of patients suffering from IDEM tumors who underwent surgical treatment over a 12 year period in a double-center experience. Data were extracted from a prospectively maintained database and included: sex, age at diagnosis, clinical status according to the modified McCormick Scale (Grades I-V) at admission, discharge, and follow-up, tumor histology, type of surgical access to the spinal canal (bilateral laminectomy vs. monolateral laminectomy vs. laminoplasty), degree of surgical removal, use and type of IONM, occurrence and type of intraoperative complications, use of Ultrasonic Aspirator (CUSA), radiological follow-up.Results: A total number of 249 patients was included with a mean follow-up of 48.3 months. Gross total resection was achieved in 210 patients (84.3%) mostly in Schwannomas (45.2%) and Meningiomas (40.4%). IONM was performed in 162 procedures (65%) and D-wave was recorded in 64.2% of all cervical and thoracic locations (99 patients). The linear regression diagram for McCormick grades before and after surgery (follow-up) showed a correlation between preoperative and postoperative clinical status. A statistically significant correlation was found between absence of worsening of clinical condition at follow-up and use of IONM at follow-up (p = 0.01) but not at discharge. No associations were found between the choice of surgical approach and the extent of resection (p = 0.79), the presence of recurrence or residual tumor (p = 0.14) or CSF leakage (p = 0.25). The extent of resection was not associated with the use of IONM (p = 0.91) or CUSA (p = 0.19).Conclusion: A reliable prediction of clinical improvement could be made based on pre-operative clinical status. The use of IONM resulted in better clinical outcomes at follow-up (not at discharge), but no associations were found with the extent of resection. The use of minimally invasive approaches such as monolateral laminectomy showed to be effective and not associated with worse outcomes or increased complications.

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Spinal Myxopapillary Ependymoma: The Sapienza University Experience and Comprehensive Literature Review Concerning the Clinical Course of 1602 Patients

Cited by 26 publications

References 48 publications

Myxopapillary Ependymoma of the Spinal Cord in Adults: a Report of Personal Series and Review of Literature

Myxopapillary Ependymoma of the Spinal Cord in Adults: a Report of Personal Series and Review of Literature

Analyzing the role of adjuvant or salvage radiotherapy for spinal myxopapillary ependymomas

Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience

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