Intramedullary Spinal Cord Ependymoma: Long-Term Clinical Evaluation after Complete Surgical Removal

Abstract

Among the various intramedullary spinal cord neoplasms mentioned in the previous chapter by Dr. Stein, ependymomas present a number of intriguing clinical and biological characteristics that offer a rather unique opportunity to evaluate certain clinical aspects of spinal cord function and recovery. First, although ependymomas are glial derived, unencapsulated tumors, the vast majority of spinal ependymomas exist in a histologically benign form with little infiltrative potential and produce a progressive myelopathy by compression of the surrounding spinal cord rather than invading fiber tracts or gray matter. Second, biological growth of spinal ependymomas is extremely slow with prodromal symptom duration usually measured in years. This slow growth is further evidenced by the frequent finding of large intramedullary ependymomas producing a thin, translucent-appearing surrounding spinal cord in patients with rather mild neurological deficit. These findings indicate a rather remarkable ability of the spinal cord to tolerate mechanical deformation secondary to a slowly expanding mass. Finally, with advances in imaging and microsurgical techniques, it has become clear that total removal of intramedullary ependymomas with acceptable morbidity and a low incidence of recurrence is now possible.^1–11