Preoperative Motor Function and Gross Total Resection as Key Predictors of Neurological Prognosis in Spinal Ependymoma Patients

Introduction: Spinal ependymomas are most common intramedullary tumors in adults. Despite surgical advancements, these tumors may recur. Identifying key factors influencing long-term prognosis is critical for improving patient management. We aimed to bridge this gap by evaluating prognostic indicators, including volumetric analyses, to enhance long-term treatment strategies in these patients.

Methods: We retrospectively reviewed 69 spinal ependymoma patients treated from 2002 to 2024. Patients were grouped by Modified McCormick Scale (MMS) into good (1-2) and poor prognosis (3-5) categories. Postoperative MRI assessed extent of resection (EOR), classifying patients as having undergone gross-total resection (GTR) or partial resection. Tumor volumes were measured using 3D Slicer®. Statistical analyses were performed with SPSS version 23. Chi-square tests compared categorical variables, while Cox proportional hazards models and Kaplan-Meier analysis estimated progression-free survival (PFS) with significance set at p < 0.05.

Results: Study included 69 patients (mean age 53.4 years; 50.7% female). Tumors were primarily cervical (37.7%) and intramedullary (82.6%), with syrinx present in 37.7%. Sixteen (23.2%) had Grade 1, 50 (72.5%) Grade 2, and 3 (4.3%) Grade 3 tumors; 11 (15.9%) received radiotherapy and 5 (7.2%) chemotherapy. Median preoperative tumor volume was 2.43 cm³ (IQR 1.47–5.57 cm³), and median postoperative tumor volume was 0 cm³ (IQR 0–0.37 cm³). Mean EOR was 85.2 ± 43.9%. Univariate analysis showed that preoperative motor deficits and higher tumor grades predicted poorer MMS outcomes (p < 0.001 and p = 0.004, respectively), while GTR improved MMS (p < 0.001). Multivariate analysis confirmed GTR and preoperative motor deficits as independent MMS predictors (p = 0.002 and p = 0.004). Mean PFS was longer for GTR group (192.3 months, 95% CI: 178.4–206.1) compared to partial resection group (149.3 months, 95% CI: 98.2–200.4) (p = 0.003).

Conclusion : Preoperative motor function and achieving GTR are crucial for favorable neurological outcomes and prolonged PFS in spinal ependymoma patients.