Microsurgery for spinal intramedullary ependymomas

English Keywords:Spinal cord  Ependymomas  Microsurgery

English Abstract:

  【Abstract】 Objective：To investigate the questions related to microsurgery for spinal intramedullary ependymomas and evaluate the surgical results and prognosis.Method：From October 2005 to Octorber 2007，36 patients with spinal intramedullary ependymomas underwent micmsurgery were analysed retrospectively.There were 27 males and 9 females with an average age of 41.2 years（range from 16 to 59 years）.Motion abnormality was in 28 cases，sensory disturbances was in 20 cases，nerve pain and local pain were in 16 cases，and sphincter dysfunction was in 6 cases.The lesions on MRI showed equal or slightly higher signal，without apparent enhancement，boundary more clearly，and some accompanied by syringomyelia.Preoperative neurological status was evaluated by McCormick grading scale，gradeⅠ in 16 cases，gradeⅡ in 11 cases，grade Ⅲ in 9 cases.The location of tumor was as follows，23 were in the cervical spinal cord，6 in the cervicothoracic spinal cord，4 in the thoracic spinal cord and 3 in the lumbar spinal cord.The tumor was romoved by the surgical treatment under microscope.Result：Total removal of tumors was achieved in 32 patients, and subtotal in 4 patients，who were treated with radiotherapy subsequently.There was no death during the operation.Surgical complications included pneumonia in 5 cases，cerebrospinal fluid leakage in 3 cases and wound infection in 1 case，all were resolved by adminstration of antibiotics or continuous lumbar subarachnoid cerebrospinal fluid drainage.The ependymoma was confirmed by postoperative pathology.McCormick grading scale：gradeⅠ in 23 cases，gradeⅡ 16 cases，grade Ⅲ 2 cases .31 cases were followed-up for a year after operation.Three cases with subtotal resection relapsed and had been re-operated within 1 year.Conclusion：Microsurgery is an effective method to treat intramedullary spinal cord tumors.Whether the tumor can be totally removed or not mainly depends on the conditions of tumor adhesion to spinal cord and microsurgical skills of the surgeons.