Characteristics and therapeutic profile of the patients with upper cervical spinal cord ependymoma from the medulla oblongata to C4: A cohort of 108 cases

Abstract

Background

Upper cervical spinal ependymomas (uCSE) is routinely identified as intramedullary ependymomas located from the oblongata medulla to C4 level. Our study aimed to report the outcomes and treatment profiles of uCSE from our cohort of uCSE patients.

Methods

This retrospective observational study included 108 patients with upper cervical spinal ependymomas (uCSE) who underwent surgery at Huashan Hospital from 2008 to 2022. Demographic and clinical data were collected to identify risk factors may associated with post-operative spinal cord function, quality of life and respiratory function.

Results

The mean age of included patients was 44.30 ± 12.71 years old. The most common uCSE was ependymoma (103 of 108, 95.37 %), followed by subependymoma (3 of 108, 2.78 %) and anaplastic Ependymoma (2 of 108, 1.85 %). Age (P = 0.003), sex (P = 0.004), duration of symptoms (P = 0.010), pre-operative bladder functions (P = 0.012), post-operative pneumonia (P = 0.013) and Carbon Dioxide Retention (CDR) (P = 0.004) could independently correlate with Iiving quality of uCSE patients. Post-operative spinal cord function was associated with pneumonia immediately after operation (P = 0.017). In addition, post-operative pneumonia correlated with tumor location (P = 0.048), pre-operative McCormick scores (P = 0.008)/ motor functions (P = 0.022)/ NRS scores (P = 0.020), and tracheotomy immediately after operation (P < 0.001). Tracheotomy immediately after operation was associated with tumor location (P = 0.023), unsteady walking (P = 0.033), pre-operative NRS scores (P = 0.029), post-operative pneumonia (P < 0.001) and CDR (P < 0.001).

Conclusion

Within uCSE patients, post-operative quality of life is associated with pre-operative spinal cord function and symptom duration, which emphasizing the importance of early intervention. Their post-operative respiratory dysfunctions also correlated with post-operative spinal cord function and quality of life.