1
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Yagi T, Mizuno M, Kageyama H, Tatebayashi K, Endo T, Takeshima Y, Iwasaki M, Kurokawa R, Takai K, Nishikawa M, Hida K. Spinal Cord Subependymoma: A Subanalysis of the Neurospinal Society of Japan's Multicenter Study of Intramedullary Spinal Cord Tumors. Neurospine 2023; 20:735-746. [PMID: 37350166 PMCID: PMC10562242 DOI: 10.14245/ns.2346388.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the clinical characteristics, treatment strategies, and surgical outcomes of subependymoma patients from the 2022 Neurospinal Society of Japan multicenter intramedullary spinal cord tumor study. METHODS Twenty-six patients with spinal cord subependymoma who were included in the index study of 1,033 patients were retrospectively analyzed. RESULTS Mean patient age was 49.4 years. Seventeen patients were men and 9 were women. Sensory disturbance was reported in 22 patients and motor weakness in 18. Median duration of symptoms was 24 months. The tumor was eccentrically located in 19 patients (73.1%) and unilateral in 17 (65.4%). Gross total resection was achieved in 6 patients (23.1%). The same rate for ependymoma patients in the index study was significantly higher (74.8%). Median follow-up was 40.5 months (interquartile range, 18-68 months). In 2 patients who underwent only partial resection, reoperation was required owing to progression 68 and 90 months after surgery, respectively. No recurrence occurred in patients who underwent gross total resection. Five patients experienced neurological worsening after surgery. CONCLUSION Although spinal cord subependymoma can be difficult to distinguish from other intramedullary spinal cord lesions before surgery, it is characterized by an indolent clinical course and eccentric location. Surgical treatment should prioritize functional preservation because the prognosis is good even after subtotal resection.
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Affiliation(s)
- Takashi Yagi
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | - Masaki Mizuno
- Department of Minimally Invasive Neurospinal Surgery, Mie University, Mie, Japan
| | - Hiroto Kageyama
- Department of Neurosurgery, Hyogo Medical University, Hyogo, Japan
| | | | - Toshiki Endo
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | | | - Motoyuki Iwasaki
- Department of Neurosurgery, Hokkaido University, Hokkaido, Japan
| | - Ryu Kurokawa
- Department of Neurosurgery, Dokkyo Medical University, Tochigi, Japan
| | - Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Misao Nishikawa
- Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, Osaka, Japan
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
| | - for the Neurospinal Society of Japan Investigators of Intramedullary Spinal Cord Tumors
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
- Department of Minimally Invasive Neurospinal Surgery, Mie University, Mie, Japan
- Department of Neurosurgery, Hyogo Medical University, Hyogo, Japan
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Neurosurgery, Nara Medical University, Nara, Japan
- Department of Neurosurgery, Hokkaido University, Hokkaido, Japan
- Department of Neurosurgery, Dokkyo Medical University, Tochigi, Japan
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
- Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, Osaka, Japan
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
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2
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Farooqi S, Tebha SS, Qamar MA, Singh S, Alfawares Y, Ramanathan V, Haider AS, Ferini G, Sharma M, Umana GE, Aoun SG, Palmisciano P. Clinical Characteristics, Management, and Outcomes of Intramedullary Spinal Cord Ependymomas in Adults: A Systematic Review. World Neurosurg 2023; 173:237-250.e8. [PMID: 36858296 DOI: 10.1016/j.wneu.2023.02.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Intramedullary spinal cord ependymomas (IMSCEs) are rare tumors that mostly occur in adults. Management strategies and related outcomes are heterogeneously reported across the literature, demanding a comprehensive analysis to standardize guidelines. We performed a systematic review of the literature on IMSCEs. METHODS A literature search was conducted using 6 databases from inception up to July 28, 2022. Studies with data on clinical characteristics, management strategies, and related outcomes in adult patients with histopathologically confirmed IMSCEs were pooled and analyzed. RESULTS The analysis included 69 studies comprising 457 patients (52.7% males). Mean age was 42.4 ± 7.4 years. Sensory deficit (58.0%) was the most prevalent symptom, followed by radicular pain (50.5%). Tumors mostly involved the cervical (64.4%) or thoracic (18.8%) spinal cord and were mostly World Health Organization grade II (80.5%) and classic subtype (72.4%). Gross total resection was performed in most cases (83.4%), with adjuvant radiotherapy delivered in 10.5% of cases. Progression-free survival ≥2 years was reported in 61.1% of cases, and tumor recurrence or progression was reported in only 7.0% of the patients. At last follow-up, 97.4% of patients were alive. CONCLUSIONS IMSCEs are uncommon tumors that frequently manifest with debilitating symptoms that require surgical treatment. When feasible, gross total resection may be pursued to improve the patient's functional status and prevent tumor progression, with adjuvant radiotherapy required only in some more aggressive grade III lesions. Future studies should investigate different growth patterns and prognoses based on different IMSCE subtypes.
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Affiliation(s)
| | - Sameer Saleem Tebha
- Department of Neurosurgery and Neurology, Jinnah Medical and Dental College, Karachi, Pakistan
| | | | - Spencer Singh
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Yara Alfawares
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Vishan Ramanathan
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Italy
| | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Salah G Aoun
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA.
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3
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Larrew T, Saway BF, Lowe SR, Olar A. Molecular Classification and Therapeutic Targets in Ependymoma. Cancers (Basel) 2021; 13:cancers13246218. [PMID: 34944845 PMCID: PMC8699461 DOI: 10.3390/cancers13246218] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
Ependymoma is a biologically diverse tumor wherein molecular classification has superseded traditional histological grading based on its superior ability to characterize behavior, prognosis, and possible targeted therapies. The current, updated molecular classification of ependymoma consists of ten distinct subgroups spread evenly among the spinal, infratentorial, and supratentorial compartments, each with its own distinct clinical and molecular characteristics. In this review, the history, histopathology, standard of care, prognosis, oncogenic drivers, and hypothesized molecular targets for all subgroups of ependymoma are explored. This review emphasizes that despite the varied behavior of the ependymoma subgroups, it remains clear that research must be performed to further elucidate molecular targets for these tumors. Although not all ependymoma subgroups are oncologically aggressive, development of targeted therapies is essential, particularly for cases where surgical resection is not an option without causing significant morbidity. The development of molecular therapies must rely on building upon our current understanding of ependymoma oncogenesis, as well as cultivating transfer of knowledge based on malignancies with similar genomic alterations.
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Affiliation(s)
- Thomas Larrew
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA; (T.L.); (B.F.S.)
| | - Brian Fabian Saway
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA; (T.L.); (B.F.S.)
| | | | - Adriana Olar
- NOMIX Laboratories, Denver, CO 80218, USA
- Correspondence: or
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4
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Oishi M, Fujisawa H, Tsuchiya K, Nakashima Y. Spinal cord subependymoma mimicking syringomyelia in a child: a case report. Childs Nerv Syst 2021; 37:2667-2671. [PMID: 33108520 DOI: 10.1007/s00381-020-04940-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
Spinal cord subependymomas (SCSEs) in children are extremely rare, and no reports distinguishing SCSEs from syringomyelia have been published. We report a case of a 10-year-old boy who presented with torticollis, scoliosis, as well as pain that had begun in the posterior portion of the neck and progressed to the right shoulder and upper arm. Magnetic resonance imaging showed an intramedullary cyst-like lesion with the same signal intensity as that of cerebrospinal fluid. Idiopathic syringomyelia with scoliosis was first suspected, and a syrinx-subarachnoid space shunt was performed. After surgery, the lesion was slightly smaller; however, 2 years after surgery, it had re-grown, causing excruciating pain but no other symptoms. A second surgery was performed, and gross total resection was achieved. Pathological evaluation revealed SCSE. SCSE needs to be considered as a differential diagnosis for spinal centric cyst-like lesions in children.
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Affiliation(s)
- Masahiro Oishi
- Department of Neurosurgery, National Hospital Organization Kanazawa Medical Center, Kanazawa, 920-8650, Ishikawa, Japan.
- Department of Neurosurgery, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Ishikawa, Japan.
| | - Hironori Fujisawa
- Department of Neurosurgery, National Hospital Organization Kanazawa Medical Center, Kanazawa, 920-8650, Ishikawa, Japan
| | - Katsuhiro Tsuchiya
- Department of Neurosurgery, National Hospital Organization Kanazawa Medical Center, Kanazawa, 920-8650, Ishikawa, Japan
| | - Yoshio Nakashima
- Department of Neurosurgery, National Hospital Organization Kanazawa Medical Center, Kanazawa, 920-8650, Ishikawa, Japan
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5
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Varrassi M, Bellisari FC, De Donato MC, Tommasino E, Di Sibio A, Bruno F, Di Vitantonio H, Splendiani A, Di Cesare E, Masciocchi C. Intracranial ependymomas: The role of advanced neuroimaging in diagnosis and management. Neuroradiol J 2021; 34:80-92. [PMID: 33525963 DOI: 10.1177/1971400921990770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Intracranial ependymomas represent a rare subgroup of glial tumours, showing a wide variety of imaging characteristics, often representing a challenging diagnosis for neuroradiologists. Here, we review the most recent scientific Literature on intracranial ependymomas, highlighting the most characteristic computed tomography and magnetic resonance imaging features of these neoplasms, along with epidemiologic data, recent classification aspects, clinical presentation and conventional therapeutic strategies. In addition, we report an illustrative case of an 18-year-old girl presenting with an intracranial supratentorial, anaplastic ependymoma, with the aim of contributing to the existing knowledge and comprehension of this rare tumour.
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Affiliation(s)
| | | | | | - Emanuele Tommasino
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
| | | | - Federico Bruno
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
| | | | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
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6
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Soleiman HA, Ironside J, Kealey S, Demetriades AK. Spinal subependymoma surgery: do no harm. Little may be more! Neurosurg Rev 2019; 43:1047-1053. [PMID: 31214945 DOI: 10.1007/s10143-019-01128-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/23/2019] [Accepted: 05/30/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Outline the reported diagnostic and operative findings, and evaluate the surgical treatment outcome to clarify the best available recommendations. METHODS Ovid Medline, Embase and PubMed central databases were searched from inception until January 2019 using the terms (subependymoma and (spinal or cervical or thoracic)). The articles were reviewed for reported spinal subependymoma cases perioperative management and treatment outcomes. RESULTS A total of 49 papers provided data on 105 cases. 47 cases were reported in the last 5 years. The reported cases were two medullary-cervical, 35 cervical, 32 cervicothoracic, 21 thoracic, 12 thoracolumbar and three lumbar. Spinal subependymomas typically arise from within the central spinal canal, giving the appearance of an intramedullary mass, usually eccentric to one side. Symptoms at presentation ranged between 1 month to 17 years, (mean 3.5 years, median 2 years) and were over 3 years in 36, and over 8 years in 12 cases. Sensory symptoms are the most frequent 75(80%), followed by weakness in 60(64%), pain in 45(48%) and sphincter disturbance in 24(25%). Postoperative neurological function was reported in 78 cases, and worsening was reported in 40 cases (51%), of which, 29 (72%) had complete resection, 6 (15%) had subtotal resection and 5 (12%) had partial resection. Neurological status remained the same in 24 (30%) and improved in 14 (18%). CONCLUSION The reviewed cases report a rate of 65% total resection of which 57% had worsened function after surgery. There were no reports of malignant transformation; therefore, long-term survival is expected, and surgical caution should be exercised where there is minimal symptom progression.
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Affiliation(s)
- Hamzah A Soleiman
- Department of Clinical Neurosciences-Neurosurgery, Lothian University Hospitals NHS trust, Edinburgh, UK.
| | - James Ironside
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Susan Kealey
- Department of Neuroradiology, Lothian University Hospitals NHS trust, Edinburgh, UK
| | - Andreas K Demetriades
- Department of Clinical Neurosciences-Neurosurgery, Lothian University Hospitals NHS trust, Edinburgh, UK
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7
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Mikula AL, Paolini MA, Sukov WR, Clarke MJ, Raghunathan A. Subependymoma involving multiple spinal cord levels: A clinicopathological case series with chromosomal microarray analysis. Neuropathology 2019; 39:97-105. [PMID: 30856298 DOI: 10.1111/neup.12543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 12/24/2022]
Abstract
Subependymomas of the spinal cord are rare, do not often involve multiple levels, and very rarely recur. Here, we present a series of spinal cord subependymomas with a detailed description of the clinical, radiological and pathological features, and characterization by chromosomal microarray analysis. Briefly, the four patients included two men and two women, between the ages of 22 and 48 years. The most common presenting symptoms were neck and arm pain with upper extremity weakness. By imaging, the tumors were found to involve multiple spinal levels, including cervical/ cervico-thoracic (three patients) and thoracic (one patient), were all eccentric, and had minimal to no post-contrast enhancement. Two patients underwent gross total resection, one had a sub-total resection, and one underwent biopsy alone with a decompressive laminectomy. Follow up ranged from 6 months to 22 years. One patient (case 4) had recurrence 15 years following gross total resection and chromosomal microarray analysis revealed deletions on the long arm of chromosome 6. Our limited series suggests that spinal cord subependymomas can rarely recur, even following gross total resection, suggesting a possible role for long-term surveillance for these rare tumors.
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Affiliation(s)
- Anthony L Mikula
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael A Paolini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - William R Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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8
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Yuh WT, Chung CK, Park SH, Kim KJ, Lee SH, Kim KT. Spinal Cord Subependymoma Surgery : A Multi-Institutional Experience. J Korean Neurosurg Soc 2018. [PMID: 29526067 PMCID: PMC5853201 DOI: 10.3340/jkns.2017.0405.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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.
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Affiliation(s)
- Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
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9
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D'Amico RS, Praver M, Zanazzi GJ, Englander ZK, Sims JS, Samanamud JL, Ogden AT, McCormick PC, Feldstein NA, McKhann GM, Sisti MB, Canoll P, Bruce JN. Subependymomas Are Low-Grade Heterogeneous Glial Neoplasms Defined by Subventricular Zone Lineage Markers. World Neurosurg 2017; 107:451-463. [PMID: 28804038 DOI: 10.1016/j.wneu.2017.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Subependymomas are infrequent, low-grade gliomas associated with the ventricular system and the spinal cord. Little is known about the origin and natural history of these slow-growing lesions. METHODS We identified all patients with pathologically proven subependymomas presenting to our institution between 1998 and 2016. We retrospectively reviewed clinical, radiographic, histologic, and surgical outcomes data in all patients who underwent surgical resection. Immunohistochemical analyses for cell lineage markers were performed. RESULTS A total of 31 patients with pathologically proven subependymomas were identified. Of these, 7 asymptomatic lesions were discovered at autopsy and 24 symptomatic cases were treated surgically. There were 15 (48%) lateral ventricle tumors, 11 (35%) fourth ventricular tumors, and 5 (17%) spinal tumors. Symptomatic intracranial lesions most commonly presented with headaches and balance and gait abnormalities. Subependymomas had no distinguishing radiographic features that provided definitive preoperative diagnosis. At last follow-up, no patient treated surgically experienced recurrence. Immunohistochemical analyses demonstrated a diffusely GFAP-positive glial neoplasm with mixed populations of cells that were variably positive for Olig2, NHERF1, Sox2, and CD44. The Ki67 proliferation index was generally low (<1% in many of the tumors). CONCLUSIONS Subependymomas demonstrate mixed populations of cells expressing glial lineage markers as well as putative stem cell markers, suggesting these tumors may arise from multipotent glial progenitors that reside in the subventricular zone. Definitive diagnosis requires surgical sampling. Although the clinical course of subependymomas appears benign, the inability to radiographically diagnose these lesions, and the possibility of an alternative malignant lesion support a low threshold for early and safe maximal resection.
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Affiliation(s)
- Randy S D'Amico
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
| | - Moshe Praver
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - George J Zanazzi
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Zachary K Englander
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Jennifer S Sims
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Jorge L Samanamud
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Alfred T Ogden
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Paul C McCormick
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Neil A Feldstein
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Michael B Sisti
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
| | - Peter Canoll
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA
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10
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Bamboo Leaf Sign as a Sensitive Magnetic Resonance Imaging Finding in Spinal Subependymoma: Case Report and Literature Review. Case Rep Neurol Med 2017; 2016:9108641. [PMID: 28074165 PMCID: PMC5198089 DOI: 10.1155/2016/9108641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/23/2016] [Indexed: 11/17/2022] Open
Abstract
Background and Importance. Subependymoma occurs very rarely in the spinal cord. We report another case of spinal subependymoma along with a review of the literature and discussion of a radiological finding that is useful for preoperative diagnosis of this tumor. Clinical Presentation. A 51-year-old man presented with a 2-year history of progressive muscle weakness in the right lower extremity. Sagittal magnetic resonance imaging (MRI) showed spinal cord expansion at the Th7–12 vertebral level. Surgical resection was performed and the tumor was found to involve predominantly subpial growth. Histological diagnosis was subependymoma, classified as Grade I according to criteria of World Health Organization. We made an important discovery of what seems to be a characteristic appearance for spinal subependymoma on sagittal MRI. Swelling of the spinal cord is extremely steep, providing unusually large fusiform dilatation resembling a bamboo leaf. We have termed this characteristic MRI appearance as the “bamboo leaf sign.” This characteristic was apparent in 76.2% of cases of spinal subependymoma for which MRI findings were reported. Conclusion. The bamboo leaf sign on spinal MRI is useful for differentiating between subependymoma and other intramedullary tumors. Neurosurgeons encountering the bamboo leaf sign on spinal MRI should consider the possibility of subependymoma.
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11
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Choi SK, Lee SH, Kim B, Minn YK, Kim KN, Kim SH. Findings from frozen sections of spinal subependymomas: Is it possible to differentiate this diagnosis from other common spinal tumors? Brain Tumor Pathol 2015; 33:19-26. [DOI: 10.1007/s10014-015-0237-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/18/2015] [Indexed: 11/28/2022]
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12
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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 2015; 20:927-34. [PMID: 24842008 DOI: 10.1007/s00776-014-0585-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 05/01/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Zhiwei Wu
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjukuku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, The First Affiliated Hospital, Xiamen University, No.55 Zhenhai Road, Siming District, Xiamen, 361003, China
| | - Akio Iwanami
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjukuku, Tokyo, 160-8582, Japan
| | - Akimasa Yasuda
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjukuku, Tokyo, 160-8582, Japan
| | - Shuji Mikami
- Department of Pathology, Keio University School of Medicine, Shinanomachi 35, Shinjukuku, Tokyo, 160-8582, Japan
| | - Yoshiaki Toyama
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjukuku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjukuku, Tokyo, 160-8582, Japan.
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13
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Wu L, Yang T, Deng X, Yang C, Zhao L, Fang J, Wang G, Yang J, Xu Y. Surgical outcomes in spinal cord subependymomas: an institutional experience. J Neurooncol 2013; 116:99-106. [PMID: 24062139 DOI: 10.1007/s11060-013-1256-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/17/2013] [Indexed: 01/04/2023]
Abstract
Spinal cord subependymomas are very rare. Most studies on spinal cord subependymomas have been case reports with literature reviews. This study presented a surgical series of 13 patients with histologically proven spinal cord subependymomas. Their clinical data, radiological findings, operative records, and follow-up outcomes were reviewed. There were 5 male and 8 female patients with a mean age of 39.5 years. The mean follow-up period was 67.8 months. Four tumors were located in the cervical spine, 5 in the cervicothoracic spine, and 4 in the thoracic spine. Gross total resection (GTR) of the tumor with a well-demarcated dissection plane was achieved in 9 cases, and subtotal resection was achieved in 4 cases. The symptoms present before the surgery were improved in 11 cases at last follow-up and the current status of 2 patients had no change compared to the preoperative presentation at last follow-up. The postoperative follow-up magnetic resonance imaging showed no recurrence in the 9 GTR cases during the mean follow-up period of 70.3 months. No recurrence/regrowth of the residual tumors was observed in the 4 STR cases during the mean follow-up period of 62.0 months. Spinal cord subependymomas are amenable to surgical resection. It is possible to achieve GTR of intramedullary subependymomas that have a well-demarcated dissection plane. When GTR cannot be achieved, STR of the lesion for decompression is advised, and follow-up imaging is needed. A good clinical outcome after GTR or STR can be expected.
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Affiliation(s)
- Liang Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China
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Krishnan SS, Panigrahi M, Pendyala S, Rao SI, Varma DR. Cervical Subependymoma: A rare case report with possible histogenesis. J Neurosci Rural Pract 2012. [PMID: 23189002 PMCID: PMC3505341 DOI: 10.4103/0976-3147.102630] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Subependymomas are extremely rare lesions of the spinal cord. Only 33 cases including ours have been reported in the cervical cord. These are typically benign slow growing tumors occurring eccentrically within the cord, producing minimal neurological deficits. The clinical, radiological, and histopathological aspects of this unusual lesion have been reviewed in detail. As the histogenesis of this tumor is much debated, we propose an alternate origin for the same.
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Affiliation(s)
- Shyam Sundar Krishnan
- Department of Neurosurgery, Krishna Institute of Medical Sciences, #1-8-31/1 Ministers Road, Secunderabad, Andhra Pradesh, India
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15
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Surgical management of intracranial subependymomas. Acta Neurochir (Wien) 2011; 153:1469-75. [PMID: 21499782 DOI: 10.1007/s00701-011-1007-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 03/24/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intracranial subependymomas are rare, slow-growing and usually non-invasive tumors. The aim of this study was to analyze our experience with the surgical treatment of intracranial subependymomas. METHODS Between 1991 and 2007, 11 patients with intracranial subependymomas had surgery in our institution. Mean age of the patients was 54.4 years (ranging from 40 to 85 years). RESULTS Tumors were located in the fourth ventricle in seven patients and in the lateral ventricle in four patients. Most patients presented with symptoms related to intracranial hypertension and/or cerebellar signs and symptoms (headache: eight patients; dizziness: six patients; nausea: six patients; gait ataxia: four patients), one patient with cognitive decline and flattened affect, and one patient with a hemiparesis. Six patients presented with hydrocephalus, but only one needed a permanent cerebrospinal fluid (CSF) shunt. Complete removal of the tumor was possible in eight cases. Following surgery, only one patient experienced a permanent drop of his Karnofsky Performance Index (from 70 to 60). Median follow-up was 37 months. There were no true recurrences during follow-up. A second surgery was required 7 years after the first operation for progression of an incompletely resected tumor. CONCLUSIONS Removal of symptomatic subependymomas can be performed safely. Prognosis is excellent after a complete resection. The potential for a surgical cure, low surgical complication rates and the risk of undertreatment of a more aggressive tumor together may justify surgery for asymptomatic lesions.
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Jang WY, Lee JK, Lee JH, Kim JH, Kim SH, Lee KH, Lee MC. Intramedullary subependymoma of the thoracic spinal cord. J Clin Neurosci 2009; 16:851-3. [DOI: 10.1016/j.jocn.2008.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 08/29/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
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17
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Orakcioglu B, Schramm P, Kohlhof P, Aschoff A, Unterberg A, Halatsch ME. Characteristics of thoracolumbar intramedullary subependymomas. J Neurosurg Spine 2009; 10:54-9. [PMID: 19119934 DOI: 10.3171/2008.10.spi08311] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Thoracolumbar intraspinal subependymomas are very rare intramedullary low-grade tumors. The authors report on the clinical and morphological features of 2 cases of thoracolumbar intraspinal subependymomas and provide midterm follow-up data. METHODS The clinical and radiological profiles of 2 patients with progressive spinal cord dysfunction due to thoracolumbar intraspinal subependymomas were retrospectively studied and compared with previously reported cases. RESULTS Patients with intraspinal subependymomas initially presented with back pain and long-tract signs. The tumors were hyperintense on T2-weighted MR imaging, isointense on T1-weighted imaging, and noncontrast enhancing. Within 1 of the tumors, a medial septum was present on axial T2-weighted imaging. The tumors were intramedullary but grew exophytically and were amenable to gentle surgical separation from normal neural structures. Therefore, gross-total resection was feasible, and neurological outcome was good. No further adjuvant therapy was conducted. On follow-up (at 58 and 18 months, respectively), no tumor recurrence was observed. CONCLUSIONS Symptomatic thoracolumbar intraspinal subependymomas with a distinct appearance on MR imaging are amenable to complete excision with favorable neurological outcome. In this study no tumor recurrence was observed at midterm follow-up in either patient, neither of whom underwent adjuvant therapy.
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Affiliation(s)
- Berk Orakcioglu
- Departments of Neurosurgery, University Hospital, Heidelberg, Germany.
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Rushing EJ, Cooper PB, Quezado M, Begnami M, Crespo A, Smirniotopoulos JG, Ecklund J, Olsen C, Santi M. Subependymoma revisited: clinicopathological evaluation of 83 cases. J Neurooncol 2007; 85:297-305. [PMID: 17569000 DOI: 10.1007/s11060-007-9411-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 05/03/2007] [Indexed: 12/16/2022]
Abstract
OBJECT Subependymomas are rare ependymal neoplasms. To date, a large clinicopathologic study of these benign neoplasms treated with modern neurosurgical techniques has not been reported. METHODS Eighty-three cases of subependymoma were retrieved from the files of the Armed Forces Institute of Pathology. Clinicopathological features were reviewed; chromogenic in situ hybridization analysis for chromosome 22 was performed (n = 8), and patient follow-up was obtained (n = 34). Overall, the patients included 68 males and 15 females, 1.5 to 85 years of age (mean, 51.0 years). Twenty-seven cases were discovered at autopsy and the remaining were surgical specimens (n = 56). Tumors arose in the posterior fossa (n = 43), lateral ventricles (n = 37), spinal cord (2) and only one arose in the temporal horn. Tumors ranged in size from 2.0 mm to 60 mm in greatest dimension (mean, 23.0 mm). Eighteen-percent (15/83) of subependymomas exhibited a mixed histologic pattern; that is, subependymoma together with another glial tumor. The most common mixture (13/15) was subependymoma and ependymoma. Surgical excision was used in all symptomatic patients; 10 patients received radiation. Four patients developed a recurrence due to incomplete excision. All patients were without evidence of disease at the last follow-up: alive (n = 28) or dead (n = 8). CONCLUSIONS Age is the only variable found to be significantly associated with survival. Currently, surgical methods result in an excellent long-term clinical outcome. Subependymomas do not appear to be associated with NF2 mutations.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Aged
- Aged, 80 and over
- Cerebral Ventricle Neoplasms/complications
- Cerebral Ventricle Neoplasms/mortality
- Cerebral Ventricle Neoplasms/pathology
- Cerebral Ventricle Neoplasms/surgery
- Child
- Child, Preschool
- Cohort Studies
- Ependymoma/complications
- Ependymoma/mortality
- Ependymoma/pathology
- Ependymoma/surgery
- Female
- Glioma, Subependymal/complications
- Glioma, Subependymal/mortality
- Glioma, Subependymal/pathology
- Glioma, Subependymal/surgery
- Humans
- Hydrocephalus/etiology
- Hydrocephalus/pathology
- Infant
- Infratentorial Neoplasms/complications
- Infratentorial Neoplasms/mortality
- Infratentorial Neoplasms/pathology
- Infratentorial Neoplasms/surgery
- Lateral Ventricles/pathology
- Male
- Middle Aged
- Mixed Tumor, Malignant/complications
- Mixed Tumor, Malignant/mortality
- Mixed Tumor, Malignant/pathology
- Mixed Tumor, Malignant/surgery
- Retrospective Studies
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- Elisabeth J Rushing
- Department of Neuropathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
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Ragel BT, Osborn AG, Whang K, Townsend JJ, Jensen RL, Couldwell WT. Subependymomas: An analysis of Clinical and Imaging Features. Neurosurgery 2006; 58:881-90; discussion 881-90. [PMID: 16639322 DOI: 10.1227/01.neu.0000209928.04532.09] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractOBJECTIVE:Subependymomas are slow-growing, benign tumors usually found incidentally in the fourth ventricle at autopsy. They are typically associated with the ventricular system and become apparent clinically only when symptoms of hydrocephalus or mass effect develop. We review clinical, histological, and contemporary radiographic presentations of 16 subependymomas, including 2 intraparenchymal tumors.METHODS:We retrospectively evaluated eight patients with pathologically proven subependymomas. Initial magnetic resonance imaging and magnetic resonance spectroscopy were reviewed when available. Imaging was also available on eight outside subependymoma cases reviewed by our radiology department.RESULTS:Twelve of these subependymomas were intraventricular, one was in the posterior fossa, two were intraparenchymal, and one was an intramedullary spinal cord tumor. These lesions were hypo- to hyperintense on T1- and T2-weighted magnetic resonance imaging, with minimal to moderate enhancement. Initial complaints included headache, seizures, tingling sensations, and weakness. Among our eight patients who underwent gross total resection with no adjuvant therapy, no recurrences have been noted on follow-up magnetic resonance imaging.CONCLUSION:Subependymomas are rare, representing only 0.51% of all central nervous system tumors operated on during an 8-year period at the University of Utah. Clinical symptoms were associated with tumor location: intracranial masses caused headaches, seizures, and neurological complaints, and spinal cord locations resulted in neurological deficit. The authors review the clinical presentation, management, and contemporary radiographic appearance of this rare tumor.
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Affiliation(s)
- Brian T Ragel
- Department of Neurosurgery, University of Utah, and Huntsman Cancer Institute, Salt Lake City 84132, USA
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Affiliation(s)
- James S Waldron
- Department of Neurological Surgery, M779, Box 0112, University of California, San Francisco, CA 94143-0112, USA.
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