• Anas Abdallah, Gökhan Baloğlu, Güler AbdallahBetülBDepartment of Psychiatry-AMATEM Unit, University of Health Sciences, Bakırköy Training and Research Hospital for Neurology Neurosurgery, and Psychiatry, Bakırköy-Istanbul, Turkey., and Gündağ PapakerMelihaMDepartment of Neurosurgery, Bezmialem Vakif University, Fatih-Istanbul, Turkey..
• Department of Neurosurgery, Istanbul Training and Research Hospital, Samatya-Istanbul, Turkey. Electronic address: abdallahanas@hotmail.com.
• World Neurosurg. 2022 Nov 1; 167: e877e890e877-e890.

BackgroundSpinal intradural-extramedullary ependymomas (IEEs) most commonly affect the lumbosacral spine. Because of their neural axis dissemination and adherence to neural structures, managing IEEs is still a controversial neurosurgical challenge. The study aimed to investigate the potential prognostic factors that influence long-term surgical outcomes by evaluating consecutively operated patients with IEEs.MethodsDuring the study period, medical records of all diagnosed patients with spinal tumors were reviewed retrospectively. This study included all patients with consecutive IEEs who underwent surgical intervention in 3 neurosurgical institutions in different periods (February 2004 to December 2020).ResultsIn 3 neurosurgical institutions, 64 (28 women, 36 men) patients were operated upon for IEE. The mean age of the patients at diagnosis was 38.9 years. The mean preoperative symptom duration was 17.8 months. Radicular pain was the most common symptom, observed in 53 patients. Gross total resection was applied to 48 patients. 54 patients had good clinical outcomes at their last follow-up after 106.9 months on average. Myxopapillary ependymoma was the most common histopathological type (n = 43). The progression was observed in 5 patients. The presence of preoperative neurological deficits, IEEs extending >2 spinal levels, bone-eroded IEEs, surgical complication, capsule violation, and incomplete resection were associated with poor prognosis.ConclusionsSeveral clinical and surgical factors can affect the functional outcomes of the surgical treatment of IEEs. Some radiological features can make neurosurgeons aware of the prognosis of IEEs. In such cases, the neurosurgeons should plan to remove tumors without violating their integrities (capsules) to obtain satisfactory functional outcomes.Copyright © 2022 Elsevier Inc. All rights reserved.

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