Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Spinal Cord Subependymoma Surgery : A Multi-Institutional Experience

  • Yuh, Woon Tak (Department of Neurosurgery, Seoul National University Hospital) ;
  • Chung, Chun Kee (Department of Neurosurgery, Seoul National University Hospital) ;
  • Park, Sung-Hye (Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Ki-Jeong (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Lee, Sun-Ho (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Kyoung-Tae (Department of Neurosurgery, Kyungpook National University Hospital)
  • Received : 2017.05.08
  • Accepted : 2017.07.25
  • Published : 2018.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : A spinal cord subependymoma is an uncommon, indolent, benign spinal cord tumor. It is radiologically similar to a spinal cord ependymoma, but surgical findings and outcomes differ. Gross total resection of the tumor is not always feasible. The present study was done to determine the clinical, radiological and pathological characteristics of spinal cord subependymomas. Methods : We retrospectively reviewed the medical records of ten spinal cord subependymoma patients (M : F=4 : 6; median 38 years; range, 21-77) from four institutions. Results : The most common symptoms were sensory changes and/or pain in eight patients, followed by motor weakness in six. The median duration of symptoms was 9.5 months. Preoperative radiological diagnosis was ependymoma in seven and astrocytoma in three. The tumors were located eccentrically in six and were not enhanced in six. Gross total resection of the tumor was achieved in five patients, whereas subtotal or partial resection was inevitable in the other five patients due to a poor dissection plane. Adjuvant radiotherapy was performed in two patients. Neurological deterioration occurred in two patients; transient weakness in one after subtotal resection and permanent weakness after gross total resection in the other. Recurrence or regrowth of the tumor was not observed during the median 31.5 months follow-up period (range, 8-89). Conclusion : Spinal cord subependymoma should be considered when the tumor is located eccentrically and is not dissected easily from the spinal cord. Considering the rather indolent nature of spinal cord subependymomas, subtotal removal without the risk of neurological deficit is another option.

Keywords

References

  1. Artico M, Bardella L, Ciappetta P, Raco A : Surgical treatment of subependymomas of the central nervous system. Acta Neurochir (Wien) 98 : 25-31, 1989 https://doi.org/10.1007/BF01407172
  2. Bardella L, Artico M, Nucci F : Intramedullary subependymoma of the cervical spinal cord. Surg Neurol 29 : 326-329, 1988 https://doi.org/10.1016/0090-3019(88)90167-X
  3. Bergman TA, Haines SJ : Subependymoma of the cervical spinal cord. A case report of long-term survival. Minn Med 74 : 21-24, 1991
  4. Bi Z, Ren X, Zhang J, Jia W : Clinical, radiological, and pathological features in 43 cases of intracranial subependymoma. J Neurosurg 122 : 49-60, 2015 https://doi.org/10.3171/2014.9.JNS14155
  5. Bostrom A, von Lehe M, Hartmann W, Pietsch T, Feuss M, Bostrom JP, et al. : Surgery for spinal cord ependymomas: outcome and prognostic factors. Neurosurgery 68 : 302-309, 2011 https://doi.org/10.1227/NEU.0b013e3182004c1e
  6. Boykin FC, Cowen D, Iannucci CA, Wolf A : Subependymal glomerate astrocytomas. J Neuropathol Exp Neurol 13 : 30-49, 1954 https://doi.org/10.1097/00005072-195401000-00006
  7. Bret P, Bougeard R, Saint-Pierre G, Guyotat J, Ricci AC, Confavreux C : Intramedullary subependymoma of the cervical spinal cord. Review of the literature a propos of a case. Neurochirurgie 43 : 158-163, 1997
  8. Casey AT, Marsh H, Wilkins P : Subependymoma of the thoracic cord: potential pitfalls in diagnosis. Br J Neurosurg 7 : 319-322, 1993 https://doi.org/10.3109/02688699309023818
  9. Cervos-Navarro J, Artigas J, Perez-Canto A : Clinical and immunohistological findings in subependymomas of the spinal cord. Verh Dtsch Ges Pathol 70 : 376-379, 1986
  10. Cure LM, Hancock CR, Barrocas AM, Sternau LL, C Hirzel A : Interesting case of subependymoma of the spinal cord. Spine J 14 : e9-e12, 2014
  11. Dario A, Fachinetti P, Cerati M, Dorizzi A : Subependymoma of the spinal cord: case report and review of the literature. J Clin Neurosci 8 : 48-50, 2001 https://doi.org/10.1054/jocn.2000.0794
  12. Dhandapani S, Anirudh S, Garg R, Vasishta RK, Vyas S : Subependymoma causing conus-cauda syndrome: cured by total excision. Neurol India 61 : 675-677, 2013 https://doi.org/10.4103/0028-3886.125375
  13. Guha A, Resch L, Tator CH : Subependymoma of the thoracolumbar cord. Case report. J Neurosurg 71(5 Pt 1) : 781-787, 1989 https://doi.org/10.3171/jns.1989.71.5.0781
  14. Herrmann H-D, Neuss M, Winkler D : Intramedullary spinal cord tumors resected with CO2 laser microsurgical technique: recent experience in fifteen patients. Neurosurgery 22 : 518-522, 1988 https://doi.org/10.1227/00006123-198803000-00011
  15. Hoeffel C, Boukobza M, Polivka M, Lot G, Guichard JP, Lafitte F, et al. : MR manifestations of subependymomas. AJNR Am J Neuroradiol 16 : 2121-2129, 1995
  16. Im SH, Paek SH, Choi YL, Chi JG, Kim DG, Jung HW, et al. : Clinicopathological study of seven cases of symptomatic supratentorial subependymoma. J Neurooncol 61 : 57-67, 2003 https://doi.org/10.1023/A:1021204616334
  17. Iwasaki M, Hida K, Aoyama T, Houkin K : Thoracolumbar intramedullary subependymoma with multiple cystic formation: a case report and review. Eur Spine J 22 Suppl 3 : S317-S320, 2013 https://doi.org/10.1007/s00586-012-2357-1
  18. Jabri HE, Dababo MA, Alkhani AM : Subependymoma of the spine. Neurosciences (Riyadh) 15 : 126-128, 2010
  19. Jain A, Amin AG, Jain P, Burger P, Jallo GI, Lim M, et al. : Subependymoma: clinical features and surgical outcomes. Neurol Res 34 : 677-684, 2012 https://doi.org/10.1179/1743132812Y.0000000064
  20. Jallo GI, Zagzag D, Epstein F : Intramedullary subependymoma of the spinal cord. Neurosurgery 38 : 251-257, 1996 https://doi.org/10.1097/00006123-199602000-00004
  21. Jang WY, Lee JK, Lee JH, Kim SH : Intramedullary subependymoma of the thoracic spinal cord. J Korean Neurosurg Soc 39 : 385-388, 2006
  22. Jin SH, Chung CK, Kim CH, Choi YD, Kwak G, Kim BE : Multimodal intraoperative monitoring during intramedullary spinal cord tumor surgery. Acta Neurochir (Wien) 157 : 2149-2155, 2015 https://doi.org/10.1007/s00701-015-2598-y
  23. Kim CH, Chung CK, Lee SH, Jahng TA, Hyun SJ, Kim KJ, et al. : Long-term recurrence rates after the removal of spinal meningiomas in relation to simpson grades. Eur Spine J 25 : 4025-4032, 2016 https://doi.org/10.1007/s00586-015-4306-2
  24. Kremer P, Zoubaa S, Schramm P : Intramedullary subependymoma of the lower spinal cord. Br J Neurosurg 18 : 548-551, 2004 https://doi.org/10.1080/02688690400012608
  25. Krishnan SS, Panigrahi M, Pendyala S, Rao SI, Varma DR : Cervical Subependymoma: a rare case report with possible histogenesis. J Neurosci Rural Pract 3 : 366-369, 2012 https://doi.org/10.4103/0976-3147.102630
  26. Lach B, Russell N, Benoit B : Atypical Subependymoma of the spinal cord: ultrastructural and immunohistochemical studies. Neurosurgery 27 : 319-325, 1990 https://doi.org/10.1227/00006123-199008000-00028
  27. Lee KS, Angelo JN, McWhorter JM, Davis CH Jr : Symptomatic subependymoma of the cervical spinal cord. Report of two cases. J Neurosurg 67 : 128-131, 1987 https://doi.org/10.3171/jns.1987.67.1.0128
  28. Lee SH, Chung CK, Kim CH, Yoon SH, Hyun SJ, Kim KJ, et al. : Longterm outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea spinal oncology research group. Neuro Oncol 15 : 921-929, 2013 https://doi.org/10.1093/neuonc/not038
  29. Matsumoto K, Nakagaki H : Intramedullary subependymoma occupying the right half of the thoracic spinal cord--case report. Neurol Med Chir (Tokyo) 42 : 349-353, 2002 https://doi.org/10.2176/nmc.42.349
  30. Matsumura A, Hori A, Spoerri O : Spinal subependymoma presenting as an extramedullary tumor: case report. Neurosurgery 23 : 115-117, 1988 https://doi.org/10.1227/00006123-198807000-00022
  31. McCormick PC, Torres R, Post KD, Stein BM : Intramedullary ependymoma of the spinal cord. J Neurosurg 72 : 523-532, 1990 https://doi.org/10.3171/jns.1990.72.4.0523
  32. Nagashima M, Isu T, Iwasaki Y, Miyamachi K, Akino M, Abe H, et al. : Intramedullary subependymoma of the cervical spinal cord. Case report. Neurol Med Chir (Tokyo) 28 : 303-308, 1988 https://doi.org/10.2176/nmc.28.303
  33. Nakasu S, Nakasu Y, Saito A, Handa J : Intramedullary subependymoma with neurofibromatosis--report of two case. Neurol Med Chir (Tokyo) 32 : 275-280, 1992 https://doi.org/10.2176/nmc.32.275
  34. Orakcioglu B, Schramm P, Kohlhof P, Aschoff A, Unterberg A, Halatsch ME : Characteristics of thoracolumbar intramedullary subependymomas. J Neurosurg Spine 10 : 54-59, 2009 https://doi.org/10.3171/2008.10.SPI08311
  35. Pagni CA, Canavero S, Giordana MT, Mascalchi M, Arnetoli G : Spinal intramedullary subependymomas: case report and review of the literature. Neurosurgery 30 : 115-117, 1992 https://doi.org/10.1227/00006123-199201000-00021
  36. Pluchino F, Lodrini S, Lasio G, Allegranza A : Complete removal of holocord subependymoma. Case report. Acta Neurochir (Wien) 73 : 243-250, 1984 https://doi.org/10.1007/BF01400858
  37. Roeder MB, Jinkins JR, Bazan C 3rd : Subependymoma of filum terminale: MR appearance. J Comput Assist Tomogr 18 : 129-130, 1994 https://doi.org/10.1097/00004728-199401000-00026
  38. Salcman M, Mayer R : Intramedullary subependymoma of the cervical spinal cord: case report. Neurosurgery 14 : 608-611, 1984 https://doi.org/10.1227/00006123-198405000-00019
  39. Salvati M, Raco A, Artico M, Artizzu S, Ciappetta P : Subependymoma of the spinal cord. Case report and review of the literature. Neurosurg Rev 15 : 65-69, 1992 https://doi.org/10.1007/BF02352071
  40. Shimada S, Ishizawa K, Horiguchi H, Shimada T, Hirose T : Subependymoma of the spinal cord and review of the literature. Pathol Int 53 : 169-173, 2003 https://doi.org/10.1046/j.1440-1827.2003.01450.x
  41. Slowik F, Pasztor E, Szollosi B : Subependymal gliomas. Neurosurg Rev 2 : 79-86, 1979 https://doi.org/10.1007/BF01649832
  42. Sohn S, Chung CK, Park SH, Kim ES, Kim KJ, Kim CH : The fate of spinal schwannomas following subtotal resection: a retrospective multicenter study by the Korea spinal oncology research group. J Neurooncol 114 : 345-351, 2013 https://doi.org/10.1007/s11060-013-1190-7
  43. Tacconi L, Johnston FG, Thomas DGT : Subependymoma of the cervical cord. Clin Neurol Neurosurg 98 : 24-26, 1996 https://doi.org/10.1016/0303-8467(95)00074-7
  44. Takami T, Yamagata T, Ohata K : Posterolateral sulcus approach for spinal intramedullary tumor of lateral location: technical note. Neurol Med Chir (Tokyo) 53 : 920-927, 2013 https://doi.org/10.2176/nmc.tn2012-0419
  45. Tan LA, Kasliwal MK, Mhanna N, Fontes RBV, Traynelis VC : Surgical resection of subependymoma of the cervical spinal cord. Neurosurg Focus 37 Suppl 2 : Video 3, 2014 https://doi.org/10.3171/2014.V3.FOCUS14258
  46. Vaquero J, Martinez R, Vegazo I, Ponton P : Subependymoma of the cervical spinal cord. Neurosurgery 24 : 625-627, 1989 https://doi.org/10.1227/00006123-198904000-00024
  47. Wu L, Yang T, Deng X, Yang C, Zhao L, Fang J, et al. : Surgical outcomes in spinal cord subependymomas: an institutional experience. J Neurooncol 116 : 99-106, 2014 https://doi.org/10.1007/s11060-013-1256-6
  48. Wu Z, Iwanami A, Yasuda A, Mikami S, Toyama Y, Nakamura M : Intramedullary cervicothoracic subependymoma: report of three cases and review of the literature. J Orthop Sci 20 : 927-934, 2015 https://doi.org/10.1007/s00776-014-0585-4
  49. Zenmyo M, Ishido Y, Terahara M, Yamamoto T, Tanimoto A, Komiya S, et al. : Intramedullary subependymoma of the cervical spinal cord: a case report with immunohistochemical study. Int J Neurosci 120 : 676-679, 2010 https://doi.org/10.3109/00207454.2010.509894

Cited by

  1. Subependymoma involving multiple spinal cord levels: A clinicopathological case series with chromosomal microarray analysis vol.39, pp.2, 2018, https://doi.org/10.1111/neup.12543
  2. Subependymoma of the Conus Medullaris with Cystic Formation: Case Report and a Literature Review vol.137, pp.None, 2020, https://doi.org/10.1016/j.wneu.2020.02.053
  3. Intramedullary Masses of the Spinal Cord: Radiologic-Pathologic Correlation vol.40, pp.4, 2018, https://doi.org/10.1148/rg.2020190196
  4. Spinal subependymoma surgery: do no harm. Little may be more! vol.43, pp.4, 2018, https://doi.org/10.1007/s10143-019-01128-x