Post-Doctoral Neurosurgery Research Fellow Johns Hopkins University Johns Hopkins University School of Medicine Baltimore, MD, US
Disclosure(s):
Abdel-Hameed Al-Mistarehi, MD: No financial relationships to disclose
Introduction: Most spinal ependymoma studies group myxopapillary and other subtypes into a single cohort. This study investigates presentation and outcome differences between ependymomas in the cervical/thoracic regions and those in the conus/filum terminale regions.
Methods: The medical records of adult patients who underwent surgical resection for spinal ependymoma at a single tertiary-care institution between 2006 and 2023 were retrospectively reviewed. Patients with subependymomas or drop metastases were excluded from the analysis.
Results: A total of 146 patients with pathologically confirmed spinal ependymoma were included, with a mean follow-up of 2.7 ± 3.5 years. The cohort was divided into two groups: cervical/thoracic (CT) ependymomas (n=101) and conus/filum (CF) ependymomas (n=45). The mean age was slightly higher in the CT group (43.3±13.2 years) compared to the CF group (40.3±14.8 years) (p=0.228). The tumors in the CT group were predominantly located in the cervical region (63.7%) and were intramedullary (100%), while the CF group tumors were mainly found in the lumbar region (90%) and were primarily extramedullary (86.7%) (p < 0.001). Tumor volume was larger in the CF group (p=0.09). Preoperative symptoms varied significantly between the two groups. Sensory disturbances were more common in the CT group (82.2% vs. 40%, p< 0.001), while pain was more frequent in the CF group (95.6% vs. 72.3%, p=0.003). Preoperative weakness was significantly more prevalent in the CT group (49.5% vs. 20.0%, p< 0.001), and gait instability was also more common in this group (p=0.03). A higher proportion of patients in the CT group required non-home discharge (35.7% vs. 8.9%, p=0.003). At the last follow-up, sensory deficits were more prevalent in the CT group (57.4% vs. 11.4%, p< 0.001), while functional independence was higher in the CF group (88.9% vs. 50.5%, p< 0.001). Multivariable analysis revealed that female sex, non-white race, and lumbar tumor location were significant predictors of increased long-term pain. Additionally, the presence of a CF tumor was associated with significantly lower odds of long-term sensory disturbances.
Conclusion : Our data demonstrate that tumor location significantly influences symptom presentation, functional improvement over time, and overall outcomes, highlighting the importance of location-based stratification in future research and treatment strategies.
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