Outcomes in spinal ependymoma: A retrospective analysis of 38 patients

Background: Spinal ependymomas are rare central nervous system tumors with an incidence of approximately 1 in 100,000. They comprise 2–6% of CNS tumors, and up to 60% of intramedullary tumors. In this study, we retrospectively analyzed prognostic factors affecting progression-free survival (PFS) and postoperative outcomes for 38 patients. Methods: Clinical and histological data were collected for 38 patients treated at a single neurosurgical center (2012–2021). Data included presenting symptoms, tumor grade and location, type of management (gross total resection [GTR], subtotal resection [STR], or conservative), use of adjuvant therapy, and outcomes such as PFS and functional status. Results: Patients averaged 55 years of age, and there was an equal gender distribution. Tumors most commonly occurred in the lumbar spine (58%), and 47% were classified as the World Health Organization Grade II. Pain was the most frequent presenting symptom (79%). GTR was achieved in 58% of patients, STR in 36%, and 13% were managed conservatively. GTR significantly reduced tumor progression compared to STR ( P = 0.008); no progression was observed in the GTR group. Functional outcomes were better with GTR; 58% of patients showed improvement postoperatively versus 50% in the STR group. Adjuvant therapy was utilized in 18% of cases and showed no significant impact on PFS or functional outcomes ( P > 0.99). The overall 5-year PFS rate was 75%. Conclusion: This study underscores the importance of GTR in reducing progression while preserving functional outcomes in spinal ependymoma. Adjuvant therapy remains controversial, with limited evidence supporting its benefit.