J Korean Neurosurg Soc.  2018 Mar;61(2):233-242. 10.3340/jkns.2017.0405.001.

Spinal Cord Subependymoma Surgery: A Multi-Institutional Experience

• Yuh WT
• Chung CK
• Park SH
• Kim KJ
• Lee SH
• Kim KT

• KMID: 2408025
• DOI: http://doi.org/10.3340/jkns.2017.0405.001

Abstract

OBJECTIVE
A spinal cord subependymoma is an uncommon, indolent, benign spinal cord tumor. It is radiologically similar to a spinal cord ependymoma, but surgical findings and outcomes differ. Gross total resection of the tumor is not always feasible. The present study was done to determine the clinical, radiological and pathological characteristics of spinal cord subependymomas.
METHODS
We retrospectively reviewed the medical records of ten spinal cord subependymoma patients (M : F=4 : 6; median 38 years; range, 21-77) from four institutions.
RESULTS
The most common symptoms were sensory changes and/or pain in eight patients, followed by motor weakness in six. The median duration of symptoms was 9.5 months. Preoperative radiological diagnosis was ependymoma in seven and astrocytoma in three. The tumors were located eccentrically in six and were not enhanced in six. Gross total resection of the tumor was achieved in five patients, whereas subtotal or partial resection was inevitable in the other five patients due to a poor dissection plane. Adjuvant radiotherapy was performed in two patients. Neurological deterioration occurred in two patients; transient weakness in one after subtotal resection and permanent weakness after gross total resection in the other. Recurrence or regrowth of the tumor was not observed during the median 31.5 months follow-up period (range, 8-89).
CONCLUSION
Spinal cord subependymoma should be considered when the tumor is located eccentrically and is not dissected easily from the spinal cord. Considering the rather indolent nature of spinal cord subependymomas, subtotal removal without the risk of neurological deficit is another option.

Keyword

Subependymoma; Ependymoma; Spine; Spinal cord; Spinal cord neoplasms; Surgery

MeSH Terms

Astrocytoma
Diagnosis
Ependymoma
Follow-Up Studies
Glioma, Subependymal*
Humans
Medical Records
Radiotherapy, Adjuvant
Recurrence
Retrospective Studies
Spinal Cord Neoplasms
Spinal Cord*
Spine

Figure

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  Fig. 1 Preoperative magnetic resonance (MR) images showing an intramedullary mass located at the C2–7 level with associated hydrosyrinx extending to T3 level. A : Sagittal T1-weighted image without contrast showing isointense lesion. B : Sagittal T1-weighted image with contrast showing poor gadolinium enhancement. C : Sagittal T2-weighted image exhibiting hyperintense lesion. D : Axial T2-weighted image showing the mass located at left and dorsal side of the spinal cord. E : Postoperative T2-weighted image revealing partial removal state of the tumor.

• 

  Fig. 2 A : Intraoperative photograph after durotomy showing an edematous spinal cord rotated to right side. B : After myelotomy, the exposed tumor is gelatinous and light grayish with indistinct dissection plane.

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  Fig. 3 A : Hematoxylin and eosin (H&E) staining of resected specimens showing lobular architecture (H&E, ×20). B : Clustered nuclei (H&E, ×100). C : With focal degenerative nuclear enlargement or pleomorphism (H&E, ×200). D : Immunostaining of specimens showing diffuse positive to GFAP (GFAP immunostainig, ×150). E : Ki-67 index was less than 1% (Ki67, ×150). GFAP : glial fibrillary acidic protein.

Reference

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