Advertisement

Journal of Neuro-Oncology

, Volume 135, Issue 1, pp 93–98 | Cite as

Natural history of intramedullary spinal cord ependymoma in patients preferring nonoperative treatment

  • Bedjan Behmanesh
  • Florian Gessler
  • Stephan Dützmann
  • Daniel Dubinski
  • Lioba Imoehl
  • Volker Seifert
  • Matthias Setzer
  • Gerhard Marquardt
Clinical Study

Abstract

Surgical resection of intramedullary spinal cord ependymoma still remains the standard of care but is challenging and occasionally associated with poor outcome. The aim of this study is therefore to provide additional information regarding the natural history of conservatively treated symptomatic intramedullary spinal cord ependymoma. Retrospective, single center review of all patients with intramedullary spinal cord ependymoma treated conservatively (wait and see) between 1980 and 2016. The neurological outcomes at first presentation, as well as in long-term follow-up, were assessed using the modified McCormick Disability Scale and modified Rankin Scale. Thirteen of 41 patients were managed conservatively and were included in the study. Mean age at the admission was 49 years. There were seven women and six men. All patients were symptomatic at the time of presentation. The mean follow-up from admission to the last neurological examination was 47.9 months. The mean modified McCormick score in conservatively treated patients was 1.3 at admission and 1.6 (p = 0.3) at last follow-up. There was no significant neurological detoriation over time in conservatively managed patients as assessed by the modified Rankin Scale at first presentation and last follow-up (mRS scores of 0–2, 100 vs 92%; p = 0.9). This cohort of conservatively managed patients with symptomatic intramedullary spinal cord ependymoma was clinically stable throughout the follow-up period. Our data provide additional information for counseling patients with intramedullary spinal cord tumors who chose a nonoperative treatment.

Keywords

Intramedullary spinal cord ependymoma Surgery Conservative therapy Neurological status Follow-up Outcome 

Notes

Funding

No funding supported this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Malis LI (1978) Intramedullary spinal cord tumors. Clin Neurosurg 25:512–539PubMedGoogle Scholar
  2. 2.
    Fakhreddine MH, Mahajan A, Penas-Prado M, Weinberg J, McCutcheon IE, Puduvalli V et al (2013) Treatment, prognostic factors, and outcomes in spinal cord astrocytomas. Neuro-Oncology 15:406–412. doi: 10.1093/neuonc/nos309 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Aghakhani N, David P, Parker F, Lacroix C, Benoudiba F, Tadie M (2008) Intramedullary spinal ependymomas: analysis of a consecutive series of 82 adult cases with particular attention to patients with no preoperative neurological deficit. Neurosurgery 62:1279-85-6. doi: 10.1227/01.neu.0000333299.26566.15 Google Scholar
  4. 4.
    Eroes CA, Zausinger S, Kreth F-W, Goldbrunner R, Tonn J-C (2010) Intramedullary low grade astrocytoma and ependymoma. Surgical results and predicting factors for clinical outcome. Acta Neurochir 152:611–618. doi: 10.1007/s00701-009-0577-x CrossRefPubMedGoogle Scholar
  5. 5.
    Shrivastava RK, Epstein FJ, Perin NI, Post KD, Jallo GI (2005) Intramedullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis. J Neurosurg Spine 2:249–255. doi: 10.3171/spi.2005.2.3.0249 CrossRefPubMedGoogle Scholar
  6. 6.
    Behmanesh B, Setzer M, Konczalla J, Harter P, Quick-Weller J, Imoehl L et al (2017) Management of patients with primary intramedullary spinal cord glioblastoma. World Neurosurg 98:198–202. doi: 10.1016/j.wneu.2016.10.075 CrossRefPubMedGoogle Scholar
  7. 7.
    Karikari IO, Nimjee SM, Hodges TR, Cutrell E, Hughes BD, Powers CJ, et al (2011) Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients. Neurosurgery 68:188–197. doi: 10.1227/NEU.0b013e3181fe3794. (discussion 197)CrossRefPubMedGoogle Scholar
  8. 8.
    Klekamp J (2013) Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results. J Neurosurg Spine 19:12–26. doi: 10.3171/2013.3.SPINE121063 CrossRefPubMedGoogle Scholar
  9. 9.
    Kothbauer KF, Deletis V, Epstein FJ (1998) Motor-evoked potential monitoring for intramedullary spinal cord tumor surgery: correlation of clinical and neurophysiological data in a series of 100 consecutive procedures. Neurosurg Focus 4:e1CrossRefPubMedGoogle Scholar
  10. 10.
    Kucia EJ, Bambakidis NC, Chang SW, Spetzler RF (2011) Surgical technique and outcomes in the treatment of spinal cord ependymomas, part 1: intramedullary ependymomas. Neurosurgery 68:57–63. doi: 10.1227/NEU.0b013e318208f181. (discussion 63)PubMedGoogle Scholar
  11. 11.
    Li T-Y, Chu J-S, Xu Y-L, Yang J, Wang J, Huang Y-H et al (2014) Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients: clinical article. J Neurosurg Spine 21:249–259. doi: 10.3171/2014.3.SPINE13481 CrossRefPubMedGoogle Scholar
  12. 12.
    Manzano G, Green BA, Vanni S, Levi AD (2008) Contemporary management of adult intramedullary spinal tumors-pathology and neurological outcomes related to surgical resection. Spinal Cord 46:540–546. doi: 10.1038/sc.2008.51 CrossRefPubMedGoogle Scholar
  13. 13.
    Matsuyama Y, Sakai Y, Katayama Y, Imagama S, Ito Z, Wakao N et al (2009) Surgical results of intramedullary spinal cord tumor with spinal cord monitoring to guide extent of resection. J Neurosurg Spine 10:404–413. doi: 10.3171/2009.2.SPINE08698 CrossRefPubMedGoogle Scholar
  14. 14.
    Nagasawa DT, Smith ZA, Cremer N, Fong C, Lu DC, Yang I (2011) Complications associated with the treatment for spinal ependymomas. Neurosurg Focus 31:E13. doi: 10.3171/2011.7.FOCUS11158 CrossRefPubMedGoogle Scholar
  15. 15.
    Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G (2005) Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery 56:972-81-81Google Scholar
  16. 16.
    Sandalcioglu IE, Gasser T, Asgari S, Lazorisak A, Engelhorn T, Egelhof T et al (2005) Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients. Spinal Cord 43:34–41. doi: 10.1038/sj.sc.3101668 CrossRefPubMedGoogle Scholar
  17. 17.
    Behmanesh B, Gessler F, Quick-Weller J, Spyrantis A, Imöhl L, Seifert V, et al (2017) Regional spinal cord atrophy is associated with poor outcome after surgery on intramedullary spinal cord ependymoma: a new aspect of delayed neurological deterioration. World Neurosurg. doi: 10.1016/j.wneu.2017.01.026.Google Scholar
  18. 18.
    McCormick PC, Torres R, Post KD, Stein BM (1990) Intramedullary ependymoma of the spinal cord. J Neurosurg 72:523–532. doi: 10.3171/jns.1990.72.4.0523 CrossRefPubMedGoogle Scholar
  19. 19.
    Schwartz TH, McCormick PC (2000) Intramedullary ependymomas: clinical presentation, surgical treatment strategies and prognosis. J Neurooncol 47:211–218CrossRefPubMedGoogle Scholar
  20. 20.
    Vera-Bolanos E, Aldape K, Yuan Y, Wu J, Wani K, Necesito-Reyes MJ et al (2015) Clinical course and progression-free survival of adult intracranial and spinal ependymoma patients. Neuro-Oncology 17:440–447. doi: 10.1093/neuonc/nou162 CrossRefPubMedGoogle Scholar
  21. 21.
    Chang UK, Choe WJ, Chung SK, Chung CK, Kim HJ (2002) Surgical outcome and prognostic factors of spinal intramedullary ependymomas in adults. J Neurooncol 57:133–139CrossRefPubMedGoogle Scholar
  22. 22.
    Lee S-H, Chung CK, Kim CH, Yoon SH, Hyun S-J, Kim K-J et al (2013) Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea Spinal Oncology Research Group. Neuro-Oncology 15:921–929. doi: 10.1093/neuonc/not038 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Nakamura M, Ishii K, Watanabe K, Tsuji T, Takaishi H, Matsumoto M et al (2008) Surgical treatment of intramedullary spinal cord tumors: prognosis and complications. Spinal Cord 46:282–286. doi: 10.1038/sj.sc.3102130 CrossRefPubMedGoogle Scholar
  24. 24.
    Kharkar S, Shuck J, Conway J, Rigamonti D (2007) The natural history of conservatively managed symptomatic intramedullary spinal cord cavernomas. Neurosurgery 60:865-72-72. doi: 10.1227/01.NEU.0000255437.36742.15 CrossRefGoogle Scholar
  25. 25.
    Liang J, Bao Y, Zhang H, Huo L, Wang Z, Ling F (2011) Management and prognosis of symptomatic patients with intramedullary spinal cord cavernoma: clinical article. J Neurosurg Spine 15:447–456. doi: 10.3171/2011.5.SPINE10735 CrossRefPubMedGoogle Scholar
  26. 26.
    Steiger H-J, Turowski B, Hänggi D (2010) Prognostic factors for the outcome of surgical and conservative treatment of symptomatic spinal cord cavernous malformations: a review of a series of 20 patients. Neurosurg Focus 29:E13. doi: 10.3171/2010.6.FOCUS10123 CrossRefPubMedGoogle Scholar
  27. 27.
    Samartzis D, Gillis CC, Shih P, O’Toole JE, Fessler RG (2015) Intramedullary Spinal Cord Tumors: Part I-Epidemiology, Pathophysiology, and Diagnosis. Global Spine J 5:425–435. doi: 10.1055/s-0035-1549029 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Klekamp J (2015) Spinal ependymomas. Part 1: Intramedullary ependymomas. Neurosurg Focus 39:E6. doi: 10.3171/2015.5.FOCUS15161 CrossRefPubMedGoogle Scholar
  29. 29.
    Abdullah KG, Lubelski D, Miller J, Steinmetz MP, Shin JH, Krishnaney A et al (2015) Progression free survival and functional outcome after surgical resection of intramedullary ependymomas. J Clin Neurosci 22:1933–1937. doi: 10.1016/j.jocn.2015.06.017 CrossRefPubMedGoogle Scholar
  30. 30.
    Lin Y, Smith ZA, Wong AP, Melkonian S, Harris DA, Lam S (2015) Predictors of survival in patients with spinal ependymoma. Neurol Res 37:650–655. doi: 10.1179/1743132815Y.0000000041 CrossRefPubMedGoogle Scholar
  31. 31.
    Yang T, Wu L, Yang C, Deng X, Xu Y (2014) Clinical features and long-term outcomes of intraspinal ependymomas in pediatric patients. Child’s Nervous Syst 30:2073–2081. doi: 10.1007/s00381-014-2528-y CrossRefGoogle Scholar
  32. 32.
    Oh MC, Tarapore PE, Kim JM, Sun MZ, Safaee M, Kaur G et al (2013) Spinal ependymomas: benefits of extent of resection for different histological grades. J Clin Neurosci 20:1390–1397. doi: 10.1016/j.jocn.2012.12.010 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of NeurosurgeryGoethe- UniversityFrankfurt am MainGermany
  2. 2.Department of NeurosurgeryUniversity Hospital, FrankfurtFrankfurtGermany

Personalised recommendations