Presentación y evolución de 26 pacientes con ependimoma espinal que recibieron tratamiento microquirúrgico en el Instituto de Neurología y Neurocirugía (Cuba)

Nelson Fuentes Rodríguez, Jorge Luis Rodríguez Loureiro, Nelson Ernesto Quintanal Cordero, Manuel Ulises de Arriba Romanidy, Norbery Jorge Rodríguez de la Paz, Mario de la Paz Rivero

Texto completo:

PDF (1 MB)

Resumen

OBJETIVO: Analizar la presentación y evolución de 26 pacientes adultos con ependimoma espinal que recibieron tratamiento microquirúrgico en el Instituto de Neurología y Neurocirugía (La Habana, Cuba).

MÉTODOS: Se estudió una serie de 26 pacientes con diagnóstico de ependimoma espinal sometidos a tratamiento con métodos microquirúrgicos. Se analizaron las manifestaciones clínicas, tiempo transcurrido antes del diagnóstico, características encontradas en los estudios de neuro–imágenes, tipo y grado de resección quirúrgica realizada, resultados postoperatorios logrados y factores pronósticos.

RESULTADOS: Las edades de los pacientes oscilaron entre 30 y 65 años, con un 61,5 % entre 41–50 años. Los trastornos de la sensibilidad fueron los primeros síntomas y los más persistentes al ingreso en 21 pacientes (80,7 %). Predominaron los ependimomas espinales localizados en la región del filum terminale, cono y cauda equina. Se logró la extirpación radical del tumor en 22 pacientes. Hubo solamente dos pacientes con recurrencia tumoral que respondieron a la radioterapia. Se alcanzó una capacidad funcional neurológica del grado 1 de la escala de McCormick en más del 80 % de la serie (20 pacientes).

CONCLUSIONES: El diagnóstico temprano y la cirugía radical de la tumoración son factores determinantes para una mínima o nula morbilidad.

Palabras clave

Ependimoma espinal; Ependimoma intramedular; Ependimoma mixopapilar; Microcirugía espinal; Neoplasias de la médula espinal; Neurocirugía; Laminectomía

Citas

Villano JL, Parker CK, Dolecek TA. Descriptive epidemiology of ependymal tumours in the United States. Br J Cancer. 2013;108(11):2367–71.

Miller DC. Surgical pathology of intramedullary spinal cord neoplasms. J. Neurooncol. 2000;47:189–94.

Tarapore PE, Naujokas A, Amin B, Tihan T, Parsa AT, Ames CP, et al. Pathology of spinal ependymomas: An institutional experience over 25 years in 134 patients. Neurosurgery. 2013 May 10. [Epub ahead of print]

Chandy MJ, Babu S. Management of intramedullary spinal cord tumours: review of 68 patients. Neurol India. 2004;47:224–28.

Ogden AT, Wetjen N, Francavilla JL. Intramedullary spinal cord tumours. [Internet]. [citado 24.10.2008]. Disponible en: http://emedicine.medscape.com/article/251133–overview

Greenwood J. Intramedullary tumours of the spinal cord. A follow–up study after total surgical removal. J Neurosurgery. 1963;20:665.

Greenwood J. Surgical removal of intramedullary tumours. J Neurosurgery. 1967;26:276–82.

McCormick PC, Torres R, Post KD, Stein BM. Intramedullary ependymoma of the spinal cord. J Neurosurgery. 1990;72(4):523–32.

Benzagmout M, Boujraf S, Oulali N, Chbani L, Amarti A, Chakour K, et al. Intradural extramedullary ependymoma: is there constantly a hormonal relationship?. Surg Neurol. 2008;70(5):536–38.

Kinsman MJ, Callahan JD, Hattab EM, Cohen–Gadol AA. Extramedullary spinal ependymoma: a diagnostic challenge and review of the literature. Clin Neurol Neurosurg. 2011;113:661–4.

Bonfield ChM, Amin D, Hamilton RL, Gerszten PC. Extramedullary ependymoma near the conus medullaris with lumbar nerve root attachment: Case report. Neurosurgery. 2011;68:831–4.

Ebert C, von Haken M, Meyer–Puttitz B, et al. Molecular genetic analysis of ependymal tumours. NF2 mutations and chromosome 22q loss occur preferentially in intramedullary spinal ependymomas. Am J Pathol. 1999;155:627–32.

Sonneland PR, Scheithauer BW, Onofrio BM. Myxopapillary ependimomas. A clinic pathologic and immunocytochemical study of 77 cases. Cancer. 1985;56:883–93.

Radhakrishnan N, Nair NS, et al. Tanycytic ependymoma of filum terminale: A case report. Clin Neurol Neurosurg. 2012;114:169–71.

Shamji MF, Benoit BG, Perry AM, Jansen GH. Giant cell ependymoma of the thoracic spine: Pathology case report. J Neurosurgery. 2009;64(3):566–67.

Adamek D, Dec M, Sobol G, Urbanowicz B, Jaworski M. Giant cell ependymoma: A case report. Clin Neurol Neurosurg. 2008;110:176–81.

Akutsu H, Shibada Y, Okazaki M, Hyodo A, Matsumura A. Intramedullary clear cell ependymoma in the cervical spinal cord: A case report. Neurosurgery. 2000; 47(6):1434–39.

Louis D, Ohgaki H, Wiestler O, Cavenee W. WHO classification of tumours of the Central Nervous System. 4th ed. Lyon: IARC Press; 2007. p. 72–78.

Oh MC, Kim JM, Kaur G, Safaee M, Sun MZ, et al. Prognosis by tumor location in adults with spinal ependymomas. Spine. 2012;12:591.

Schwartz TH, McCormick PC. Intramedullary ependymomas: clinical presentation, surgical treatment strategies and prognosis. J Neurooncol. 2000; 47(3):211–18.

Patrona A, Harders A, Schmieder K, Scholz M. Intraventricular bleeding and transient hydrocephalus in a patient with hemorrhagic filum terminale ependymoma undergoing anticoagulation therapy with fherprocouman. Clin Neurol Neurosurg. 2010;112:552–57.

Voulgaris S, Alexiou GA, Zigouris A, Fotakopoulos G, Michos E, et al. Spinal ependymomas: prognostic factors and treatment results. J Neurosurg Spine. 2013; 18(3):226–35.

Waldron JJ, Cha S. Radiographic features of intramedullary spinal cord tumours. Neurosurg Clin N Am. 2006;17(1):13–9.

Fuentes RN, Felipe AM, Quintanal NC, Rodríguez NJP, et al. Ependimoma intradural extramedular primario. Rev Cub Med Mil. [revista en la Internet]. 2004 [citado 28.06.2013];33(1): Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138–65572004000100009&lng=es.

Kucia EJ, Bambakidis NC, Chang SW, Spetzler RF. Surgical technique and outcomes in the treatment of spinal cord ependymomas, Part 1: Intramedullary ependymomas. Neurosurgery. 2011;68(ONS suppl 1):ons57–ons63.

Kucia EJ, Manghan PH, Kakarla UK, Bambakidis NC, Spetzler RF. Surgical technique and outcomes in the treatment of spinal cord ependymomas, Part 2: Myxopapillary ependymoma. Neurosurgery. 2011;68(ONS 1):ons90–ons94.

Lee SH, Chung CK, Kim CH, Yoon SH, Hyun SJ, et al. Long–term 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. J Cancer Res Ther. 2013;9(1):60–3.

Halvorsen CM, Kolstad F, Hald J, Johannesen TB, Krossnes BK, Langmoen IA, et al. Long–term outcome after resection of intraspinal ependymomas: Report of 86 consecutive cases. Neurosurgery. 2010;67(6):1622–31.

Wahab SH, Simpson JR, Michalski JM, Mansur DB. Long term outcome with post–operative radiation therapy for spinal canal ependymoma. J. Neurooncol. 2007;83(1):85–9.

Fernandes AJ, Dos Santos MJ, Tedeshi H. Surgical management of intramedullary spinal ependymomas. Arq Neuropsiquiatr. 2009;67(2–A):284–9.

Bagley CA, Wilson S, Kothbaver KF, Bookland MS, Epstein F, Jallo GL. Long term outcomes following surgical resection of myxopapillary ependymomas. Neurosurg Rev. 2009;32(3):321–4.

Boström A, von Lehe M, Hartmann W, Pietsch T, Feuss M, Boström JP, et al. Surgery for spinal cord ependymomas: Outcome and prognostic factors. Neurosurgery. 2011;63:302–9.

Karikari IO, Nimjee SM, Hodges TR, Cutrell E, Hughes BD, Powers CJ, et al. Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: A single–center experience with 102 patients. Neurosurgery. 2011;68:188–97.