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Clinical characteristics and surgical outcomes of ependymomas in the upper cervical spinal cord: a single-center experience of 155 consecutive patients

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Abstract

Ependymomas occurring in the upper cervical spinal cord (above the level of the C4 segment) are rare entities with great therapeutic challenges. This study was aimed to investigate the clinicoradiological characteristics and the prognosis in a large cohort of upper cervical ependymomas from a single institution. This retrospective study enrolled 155 patients with primary ependymomas in the upper cervical spinal cord. The pre- and post-operative clinical and magnetic resonance imaging profiles were collected. The neurological outcomes and survival events were evaluated, and potential independent risk factors were analyzed. There were 82 females and 73 males, with an average age of 43.1 ± 11.3 years. Immediately post-operatively, 118 (76.1%) patients experienced neurological deterioration and 32 (20.7%) patients remained unchanged. Three months after surgery, 61 (39.4%) patients showed deteriorated neurological functions compared to the pre-operative baseline levels. After an average follow-up period of 56.0 ± 24.7 months, the neurological functions were worse than the baseline status in 37 (23.9%) patients and improved in 33 (21.3%) patients, respectively. Logistic regression analysis identified that lower age (≤ 42 years) and lower pre-operative MMS (I–II) were independent protective factors for predicting favorable neurological functions. Multivariate Cox regression analysis revealed that incomplete resection was the only independent risk factor associated with a shorter progression-free survival. Age and pre-operative functional status affect the long-term neurological outcomes, and incomplete resection was associated with a shorter survival. Our findings indicate that gross total resection should be the goal of surgical treatment of upper cervical ependymomas.

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Fengtai District, Beijing, 100070, China

    Xiaobin Fei, Wenqing Jia, Da Li, Zenghui Qian, Bo Han, Dejiang Wang & Yulun Xu

  2. China National Clinical Research Center for Neurological Diseases (NCRC-ND), Fengtai District, Beijing, 100070, China

    Xiaobin Fei, Wenqing Jia, Da Li, Zenghui Qian, Bo Han, Dejiang Wang & Yulun Xu

  3. Department of Neurosurgery, The Affiliated Jiangyin People’s Hospital of Southeast University Medical College, Wuxi, 214400, Jiangsu, China

    Xiaobin Fei & Heng Gao

  4. Department of Orthopedics, Peking University Third Hospital, Haidian District, Beijing, 100191, China

    Chenlong Yang

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  1. Xiaobin Fei
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Correspondence to Yulun Xu.

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Fei, X., Jia, W., Gao, H. et al. Clinical characteristics and surgical outcomes of ependymomas in the upper cervical spinal cord: a single-center experience of 155 consecutive patients. Neurosurg Rev 44, 1665–1673 (2021). https://doi.org/10.1007/s10143-020-01363-7

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