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October2013 Vol.50 Issue:        4        Table of Contents
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Prognostic Factors for Neurological Outcome after Resection of Intramedullary Spinal Cord Ependymoma

Mohamed Abdel Bari Mattar1, Ashraf Shaker Zidan1, Mohammad Abu-Hegazy2, Hassan Salama2, Hend Ahmed El-Hadaad3, Samar Galal Younis4, Mohamed Saad2

Departments of Neurosurgery1, Neurology2, Clinical Oncology and Nuclear Medicine3, Mansoura University;

Clinical Oncology4, Tanta University; Egypt


Background: Radical resections of spinal ependymomas were made possible by many neurosurgeons with the advantages of electrophysiological spinal cord monitoring. Objective: To clarify the good neurological outcome prognostic factors and survival after surgical excision of spinal ependymomas. Methods: The current study enrolled 25 patients with spinal ependymomas. Neurological function and MRI were evaluated preoperatively, at discharge, 6-month and 12-month thereafter. Factors associated with gross-total resection (GTR), progression-free survival (PFS), and long-term neurological improvements were assessed. Results: The mean age was 40 years. All pathological types of ependymomas are included. GTR was achieved in 22 cases (88%). Nine patients (36%) experienced acute neurological decline post-operatively where 7 (77.7%) of them were older and had bad preoperative baseline. In 5 patients (20%) showed tumor progression after 13 months follows up. Tumor histology, the presence of an intraoperatively identified tumor plane and adjuvant radiotherapy correlated with improved PFS. Twenty two patients (88%) maintained neurological improvement after 12 months. The presence of neurological symptoms improvement before discharge was associated with overall good outcome (mean 13 months). Conclusion: GTR can be safely achieved in the majority of spinal ependymoma when an intraoperative plane is identified, independent of pathological subtype. The incidence of acute perioperative neurological decline increases with patient age but will improve to baseline in nearly most of patients within 1 month. Long-term improvement in motor, sensory, and bladder dysfunction occurs more frequently in patients with identified surgical plane; therefore a GTR should be attempted for all ependymomas. [Egypt J Neurol Psychiat Neurosurg.  2013; 50(4): 377-382]

Key Words: ependymoma-resection -predictors –neurological outcome

Correspondence to Hassan Salama, Department of Neurology, Mansoura University, Egypt. Tel.: +201005067491   e-mail:

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