Asian Spine J.  2020 Dec;14(6):821-828. 10.31616/asj.2020.0064.

Poor Prognostic Factors for Surgical Treatment of Spinal Intramedullary Ependymoma (World Health Organization Grade II)

• Tsuji O
• Nagoshi N
• Ishii R
• Nori S
• Suzuki S
• Okada E
• Fujita N
• Yagi M
• Matsumoto M
• Nakamura M
• Watanabe K

• KMID: 2510559
• DOI: http://doi.org/10.31616/asj.2020.0064

Abstract

Study Design: Single-center retrospective study. Purpose: We aimed to explore the postoperative prognostic factors for spinal intramedullary ependymoma. Overview of Literature: Ependymoma (World Health Organization grade II) is the most frequent intramedullary spinal tumor and is treated by total resection. However, postoperative deterioration of motor function occasionally occurs.
Methods
Eighty patients who underwent surgical resection at Keio University and Fujita Health University in Tokyo, Japan between 2003 and 2015 with more than 2 years of follow-up were enrolled. A good surgical result was defined as an improvement in the modified McCormick Scale score by one grade or more or having the same clinical grade as was observed preoperatively. Meanwhile, a poor result was defined as a reduction in the McCormick Scale score of one grade or more or remaining in grade IV or V at final follow-up. Univariate and multivariate logistic regression analyses of the following factors were performed in the two groups: sex, age, preoperative Visual Analog Scale (VAS), tumor location, the extent of tumor resection, hemosiderin caps, cavity length, and tumor length on magnetic resonance imaging.
Results
At final follow-up, 15 patients were included in the poor results group and 65 in the good results group. In the univariate analysis, the factors related to poor results were as follows: higher age, preoperative McCormick Scale score severity, higher preoperative VAS, thoracic location, hemosiderin capped, and non-gross total resection (GTR). A multiple logistic regression analysis was conducted and showed that age, worse preoperative McCormick Scale score, and non-GTR were significant factors for poor prognosis.
Conclusions
The independent risk factors for motor deterioration after ependymoma resection were age, worse preoperative McCormick Scale score, and non-GTR. Early surgery for patients with even mild neurological disorders could facilitate functional outcomes. These results may contribute to determining the optimal timing of surgery for spinal intramedullary ependymoma.

Keyword

Spinal intramedullary ependymoma; Surgical outcome; Prognostic factor; McCormick Scale