OBJECTIVE: To characterize functional recovery, imaging phenotype, and survival in surgically treated spinal ependymomas and to explore clinicopathological and radiologic correlates of postoperative course. METHODS: We retrospectively reviewed 48 consecutive patients (55 surgical procedures) with pathologically confirmed spinal ependymoma, including both intramedullary and intradural-extramedullary/filum lesions. Collected variables included demographics, tumor location and MRI phenotype (axial position, cyst formation, syrinx, cord edema, enhancement), extent of resection, pathological subtype/grade, Ki-67, complications, recurrence/progression, and follow-up. Functional outcomes were assessed pre- and postoperatively using the modified McCormick Scale (mMCS) and Karnofsky Performance Status (KPS). Kaplan-Meier methods estimated progression-free survival (PFS) and overall survival (OS) with log-rank comparisons; univariable Cox models (cluster-robust for repeated procedures) estimated hazard ratios (HR). Because numerous exploratory comparisons were performed, p-values were corrected with the Benjamini-Hochberg false-discovery rate. RESULTS: Mean age was 37.8 ± 14.5 years; 62.5% were male. Tumors were most commonly cervical (43.6%) and lumbar (38.2%); 56.4% were intramedullary and 43.6% extramedullary. Pathology included WHO grade 2 ependymoma (63.6%), myxopapillary ependymoma (29.1%), and WHO grade 3 ependymoma (7.3%). Gross-total resection (GTR) was achieved in 85.5% of procedures. Complications occurred in 9.1% and recurrence/progression in 23.6%; median follow-up was 22 months (mean 31.2 ± 28.8). KPS improved significantly (p 3% (PFS HR 3.7; OS HR 7.2) were associated with worse outcomes. After false-discovery-rate correction, only pathological subtype remained significant; earlier associations of syrinx and anatomical level with PFS were not confirmed. Intramedullary and extramedullary tumors did not differ significantly in PFS or OS. CONCLUSIONS: Postoperative gains were more consistently captured by KPS than mMCS. Maximal safe resection remains central to tumor control and survival, while MRI phenotype and Ki-67 may provide additional, hypothesis-generating prognostic context for surveillance planning.
Paker et al. (Fri,) studied this question.