Abstract and Introduction
Abstract
Spinal cord ependymomas are rare neoplasms, comprising approximately 5% of all CNS tumors and 15% of all spinal cord tumors. Although surgery was once reserved for diagnosis alone, the evolution of surgical practices has elevated resection to the treatment of choice for these lesions. While technological advances continue to improve the capacity for gross-total resections and thus decrease the risk of recurrence, ependymoma spinal surgery still contains a variety of potential complications. The presence of neurological deficits and deterioration are not uncommonly associated with spinal cord ependymoma surgery, including sensory loss, dorsal column dysfunction, dysesthetic syndrome, and bowel and bladder dysfunction, particularly in the immediate postoperative period. Surgical treatment may also lead to wound complications and CSF leaks, with increased risk when radiotherapy has been involved. Radiation therapy may also predispose patients to radiation myelopathy and ultimately result in neurological damage. Additionally, resections of spinal ependymomas have been associated with postoperative spinal instability and deformities, particularly in the pediatric population. Despite the advances in microsurgical techniques and intraoperative cord monitoring modalities, there remain a number of serious complications related to the treatment of spinal ependymoma tumors. Identification and acknowledgment of these potential problems may assist in their prevention, early detection, and increased quality of life for patients afflicted with this disease.
Introduction
Spinal cord ependymomas are rare neoplasms and present around a mean age of 40 years. They constitute 3% to 6% of all CNS tumors and 15% of all spinal cord tumors. These lesions are predominantly slow-growing, benign tumors that tend to compress adjacent structures rather than infiltrate cord parenchyma, resulting in associated symptoms. In order of decreasing frequency, presentation may include neck or back pain, sensory deficits, motor weakness, and bowel and bladder dysfunction.
The WHO classified ependymomas into 4 distinct subtypes: subependymomas, myxopapillary ependymomas, classic ependymomas, and anaplastic ependymomas. Spinal ependymomas may affect any age group, but they are typically found in adults and comprise the myxopapillary or classic subtypes. Myxopapillary ependymomas are generally encapsulated and reside primarily in the conus medullaris, but may extend to the cauda equina. Classic ependymomas generally form in the cervical spine, but occasionally develop in the thoracic region (Fig. 1).
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Figure 1.
Sagittal T2-weighted MR image demonstrating a cervical intramedullary ependymoma. Reprinted with permission from Kelleher MO, et al: J Neurosurg Spine 8:215–221, 2008.
While the prognosis for spinal ependymomas is generally very good, there are a number of potential complications associated with their treatment that necessitate a greater awareness. As such, identification and prevention of these key issues may allow for improved outcomes in this patient population.