Early surgical treatment of multi-segmet intramedullary cervical spinal cord ependymoma / 北京大学学报(医学版)

ABSTRACT

Objective:To investigate the early clinical treatment and prognosis of multi-segment intramedullary cervical ependymoma.Methods:Twenty patients with multi-segment (more than 3 segments) intramedullary spinal ependymoma (McCormic grade Ⅰ) were microsurgically treated with assistance of intraoperative neuroelectrophysiological monitoring.None of them received postoperative radiotherapy.Preoperatively all the patients underwent MRI examination and their neurologically function was assessed by McCormic classification method.They were followed up for an average of 2.7 years (The follow-up ranged from 3 months to 4 years).All the patients underwent review of the MRI examination and their postoperative neurological function was assessed by McCormic classification method again.Evaluation was accomplished according to the results of the follow-up.Results:All tumors were intramedullary.The length of the tumor body varied from 3 to 8 vertebral segments with an average of 4.2 vertebral segments.Gross total removal was achieved in all the 20 patients through one-stage operation.The pathology of these patients was ependymoma (WHO grades Ⅰ to Ⅱ).Two cases were lost during the follow-up due to the change of contact,but the hospital records of them showed that they recovered well at discharge.Eighteen cases were followed up constantly after operation.A case which ran through the whole cervical spinal cord had short-term mild motor dysfunction after operation,which manifested as weakness of the left side muscle strength to grade Ⅳ (which recovered to grade Ⅴ during the follow-up period).Results of the follow-up showed that these 18 patients recovered well.Preoperative symptoms,such as limb numbness and painness were significantly alleviated.There was no obvious motor dysfunction.The bowel and bladder function of these 18 patients were almost normal.The McCormic scores of these 18 patients remained in grade Ⅰ.No recurrence was found on review of the MRI examination.The main complications were a certain degree of deep sensory disturbance of lower extremities.The operation did not significantly affect the patient's life and work.Conclusion:Aggressive surgical therapy is a good treatment strategy for early multi-segment intramedullary cervical ependymoma.There is nearly no recurrence after operation and no postoperative radiotherapy is needed after gross total removal of tumors.