Dougherty Mark C, Sandhu Mani Ratnesh S, Teferi Nahom, Noeller Jennifer L, Rosinski Clayton L, Park Brian J, Menezes Arnold H, Nourski Kirill V, Hitchon Patrick W
J Neurosurg Spine. 2023 Jun 30;39(4):548-556. doi: 10.3171/2023.5.SPINE23433. Print 2023 Oct 1.
Myxopapillary ependymomas (MPEs) are low-grade, well-circumscribed tumors that often involve the conus medullaris, cauda equina, or filum terminale. They account for up to 5% of all tumors of the spine and 13% of spinal ependymomas, with a peak incidence between 30 and 50 years of age. Because of the rarity of MPEs, their clinical course and optimal management strategy are not well defined, and long-term outcomes remain difficult to predict. The objective of this study was to review long-term clinical outcomes of spinal MPEs and identify factors that may predict tumor resectability and recurrence.
Pathologically confirmed cases of MPE at the authors' institution were identified and medical records were reviewed. Demographics, clinical presentation, imaging characteristics, surgical technique, follow-up, and outcome data were noted. Two groups of patients-those who underwent gross-total resection (GTR) and those who underwent subtotal resection (STR)-were compared using the Mann-Whitney U-test for continuous and ordinal variables and the Fisher exact test for categorical variables. Differences were considered statistically significant at p ≤ 0.05.
Twenty-eight patients were identified, with a median age of 43 years at the index surgery. The median postoperative follow-up duration was 107 months (range 5-372 months). All patients presented with pain. Other common presenting symptoms were weakness (25.0%), sphincter disturbance (21.4%), and numbness (14.3%). GTR was achieved in 19 patients (68%) and STR in 9 (32%). Preoperative weakness and involvement of the sacral spinal canal were more common in the STR group. Tumors were larger and spanned more spinal levels in the STR group compared with the GTR cohort. Postoperative modified McCormick Scale grades were significantly higher in the STR cohort compared with the GTR group (p = 0.00175). Seven of the 9 STR patients (77.8%) underwent reoperation for recurrence at a median of 32 months from the index operation, while no patients required reoperation after GTR, for an overall reoperation rate of 25%.
Findings of this study emphasize the importance of tumor size and location-particularly involvement of the sacral canal-in determining resectability. Reoperation for recurrence was necessary in 78% of patients with subtotally resected tumors; none of the patients who underwent GTR required reoperation. Most patients had stable neurological status postoperatively.
黏液乳头型室管膜瘤（MPE）是一种低度恶性、边界清晰的肿瘤，常累及脊髓圆锥、马尾或终丝。它们占所有脊柱肿瘤的5%，占脊髓室管膜瘤的13%，发病高峰年龄在30至50岁之间。由于MPE罕见，其临床病程和最佳治疗策略尚未明确界定，长期预后仍难以预测。本研究的目的是回顾脊柱MPE的长期临床结果，并确定可能预测肿瘤可切除性和复发的因素。
确定作者所在机构经病理证实的MPE病例，并查阅病历。记录人口统计学、临床表现、影像学特征、手术技术、随访情况和结果数据。使用Mann-Whitney U检验比较两组患者——接受全切除（GTR）的患者和接受次全切除（STR）的患者——的连续变量和有序变量，使用Fisher精确检验比较分类变量。p≤0.05时差异被认为具有统计学意义。
共确定28例患者，初次手术时的中位年龄为43岁。术后中位随访时间为107个月（范围5 - 372个月）。所有患者均有疼痛症状。其他常见症状包括无力（25.0%）、括约肌功能障碍（21.4%）和麻木（14.3%）。19例患者（68%）实现了GTR，9例患者（32%）实现了STR。STR组术前无力和骶管受累更为常见。与GTR组相比，STR组肿瘤更大，跨越的脊髓节段更多。与GTR组相比，STR组术后改良McCormick量表评分显著更高（p = 0.00175）。9例STR患者中有7例（77.8%）因复发在初次手术后中位32个月时接受了再次手术，而GTR术后无患者需要再次手术，总体再次手术率为25%。
本研究结果强调了肿瘤大小和位置——特别是骶管受累——在决定可切除性方面的重要性。78%接受次全切除的患者因复发需要再次手术；接受GTR的患者均无需再次手术。大多数患者术后神经功能状态稳定。
