Introduction: Myxopapillary ependymomas (MPE) are an often-indolent type of spinal cord tumor arising from ependymal glial cells of the filum terminale and affecting structures of the cauda equina region. First-line treatment includes surgical resection, with adjuvant radiotherapy for subtotal resections. This analysis characterizes a cohort of patients with MPE who underwent treatment at a single center.
Methods: Natural language processing was used to query the electronic health record at a single academic medical center for the term “myxopapillary ependymoma.” Results were manually verified for accuracy, and descriptive data regarding patient demographics, surgery characteristics, and postoperative courses were extracted for analysis.
Results: Our search identified 31 patients with 33 individual resections, which took place between June 2011-June 2024. Median follow-up time was 17.2 months (1.8 – 147.1). Of the identified surgeries, 29 were for primary disease and four for recurrent tumors. Intraoperative visualization revealed cauda equina involvement in 30 cases (88.2%) and conus medullaris in 12 (35.3%). En-bloc resections (n=13) yielded gross total resection (GTR) in every case, versus 15 GTRs resulting from 20 piecemeal resections (75.0%). Recurrence, including local or dissemination, occurred following five initial resections and two repeat resections for seven instances total (20.6%) at a median 376 days post-resection (33-1,795 days). All recurrence occurred following piecemeal resections. For patients with recurrence after initial resection, management included open resection (n=2), planned radiation therapy (n=2), or gamma knife radiation (n=1). Two patients with disease recurrence after repeat surgery were subsequently managed with radiation therapy. All patients were recurrence-free at most recent follow-up. Complications requiring reoperation included one intradural hematoma, one wound infection requiring debridement, and one postoperative systemic infection requiring biopsy to confirm osteomyelitis. One patient death occurred from cerebral herniation on postoperative day one.
Conclusion : Spinal MPEs heterogeneously affect lumbosacral neural structures and resection approach may affect recurrence.