de Jong Lars, Calenbergh Frank Van, Menten Johan, van Loon Johannes, De Vleeschouwer Steven, Plets Christiaan, Didgar Mehrnaz, Sciot Raf, Goffin Jan
Department of Neurosurgery, University Hospitals Leuven, Belgium.
Surg Neurol Int. 2012;3:76. doi: 10.4103/2152-7806.98509. Epub 2012 Jul 14.
Ependymomas of the filum terminale (EFT) form a specific and relatively uncommon subtype of spinal cord ependymomas. Most series in the literature are small, spanning a large time period. Up to date no consensus has been reached about the optimal treatment of these lesions. Some authors promote postoperative radiotherapy for all cases, others advocate postoperative radiotherapy only when a subtotal resection is performed or when metastasis are apparent.
We performed a retrospective analysis of 22 patients with an EFT (mean age at diagnosis of 35.6 years).
In all patients (9/22) with lesions smaller than 4.5 cm no metastases were present and a complete resection could be obtained. No adjuvant radiotherapy was performed and at latest follow they had an excellent outcome. In our series, these initial tumor characteristics were more important regarding prognosis than either histology or treatment-related factors. For the larger tumors, total resection was obtained less frequently, more dissemination was diagnosed and a worse outcome was scored. Radiotherapy if indicated did lead to an acceptable disease control.
In every case of EFT, an individual treatment protocol has to be outlined, but if an EFT is relatively small and can be resected completely, we would advocate to withhold radiotherapy.
终丝室管膜瘤（EFT）是脊髓室管膜瘤中一种特殊且相对少见的亚型。文献中的多数病例系列规模较小，时间跨度大。目前对于这些病变的最佳治疗方法尚未达成共识。一些作者主张对所有病例均进行术后放疗，另一些人则认为仅在次全切除或有明显转移时才进行术后放疗。
我们对22例终丝室管膜瘤患者（诊断时平均年龄35.6岁）进行了回顾性分析。
所有病变小于4.5 cm的患者（9/22）均无转移，且能够实现完全切除。未进行辅助放疗，在最近一次随访时，他们的预后良好。在我们的病例系列中，这些初始肿瘤特征对预后的影响比组织学或治疗相关因素更为重要。对于较大的肿瘤，全切除的频率较低，更多的播散被诊断出来，预后评分较差。如果有指征进行放疗，确实能实现可接受的疾病控制。
对于每一例终丝室管膜瘤，都必须制定个体化的治疗方案，但如果终丝室管膜瘤相对较小且能够完全切除，我们主张不进行放疗。
