Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients

Clinical article

XiaoDong Liu Ph.D., M.D., Bing Sun Ph.D., M.D., QiWu Xu Ph.D., M.D., XiaoMing Che Ph.D., M.D., Jie Hu Ph.D., M.D., ShiXin Gu Ph.D., M.D., and JiaJun Shou M.D.
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  • Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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Object

Little is known regarding the anaplastic variant of primary ependymomas that involve the spinal cord. The aim of this study was to evaluate the clinical characteristics and treatment outcomes of primary spinal anaplastic ependymomas (PSAEs).

Methods

Medical records were reviewed in 20 patients with pathologically proven PSAEs who underwent surgical treatment at the Department of Neurosurgery in Huashan Hospital between 1999 and 2008.

Results

This series included 7 women and 13 men between the ages of 2 and 67 years (mean 31.9 years). The mean preoperative course was 9.3 months (range 20 days to 48 months). The most common PSAE locations were the cervical and thoracic spinal cords. The most common presenting symptom was weakness, followed by numbness, bowel or bladder dysfunction, and pain. Gross-total resection (GTR) was achieved in 17 patients, and a subtotal removal was performed in 3 patients. Nine patients received radiation therapy and/or chemotherapy. The mean follow-up duration was 83.5 months. Functional assessment of the 10 patients available at the latest follow-up evaluation showed that 2 had worsened and 8 remained unchanged from their preoperative status. There were 2 local recurrences and 1 lung metastasis.

Conclusions

Patients with PSAEs presented with a much shorter preoperative course than patients with Grade II ependymomas in previous studies. Patients with tumors that involved the cervical spinal cord experienced a worse outcome. Surgical removal of PSAEs, with the goal of GTR, is beneficial to patients. The role of radiation therapy and chemotherapy in PSAEs remains to be determined in further studies.

Abbreviations used in this paper:AIS = American Spinal Injury Association Impairment Scale; GTR = gross-total resection; PSAE = primary spinal anaplastic ependymoma; STR = subtotal resection.

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Contributor Notes

Drs. Liu and Sun contributed equally to this work.

Address correspondence to: XiaoMing Che, Ph.D., M.D., Department of Neurosurgery, Huashan Hospital, Fudan University, No. 12 Mid Wulumuqi Road, Shanghai, China 200040. email: xiaoming_che@yahoo.com.cn.

Please include this information when citing this paper: published online May 10, 2013; DOI: 10.3171/2013.3.SPINE12183.

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