Presenting symptoms and outcomes of cervical and thoracic ependymomas compared to conus and filum ependymomas

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OBJECTIVE: Prior studies on spinal ependymoma typically group patients based on tumor pathology, often combining myxopapillary ependymomas and other ependymoma subtypes into a single cohort. This study aimed to evaluate differences in patient presentation and long-term functional outcomes between cervical/thoracic and conus/filum ependymomas. The authors hypothesized that these variations are location specific and warrant further stratification. METHODS: The medical records of adult patients who underwent resection for spinal ependymoma at a single tertiary-care institution between 2006 and 2023 were retrospectively reviewed. RESULTS: A total of 146 patients with pathologically confirmed spinal ependymoma were included, with a mean follow-up of 2.2 ± 3.1 years. The cohort was divided into two groups: cervical/thoracic ependymomas (n = 101) and conus/filum ependymomas (n = 45). The tumors in the cervical/thoracic group were predominantly located in the cervical region (68.3%) and were intramedullary (100%), while the conus/filum group tumors were mostly found in the lumbar region (88.9%) and were primarily extramedullary (86.7%) (p < 0.001). Preoperative symptoms varied significantly between the two groups. Sensory disturbances were more common in the cervical/thoracic group (82.2% vs 40%, p < 0.001), while pain was more frequent in the conus/filum group (95.6% vs 74.3%, p = 0.003). Preoperative weakness was significantly more prevalent in the cervical/thoracic group (49.5% vs 20.0%, p < 0.001), and gait instability was also more common in this intramedullary group (p = 0.03). A higher proportion of patients in the cervical/thoracic group required nonhome discharge (35.7% vs 8.9%, p = 0.003). At the last follow-up, sensory deficits were more prevalent in the cervical/thoracic group (57.4% vs 11.1%, p < 0.001), while functional independence was significantly higher in the conus/filum group (95.6% vs 90.1%, p < 0.001). Multivariable analysis revealed that female sex, non-White race, and lumbar tumor location were significant predictors of pain at last follow-up. Additionally, the presence of a conus/filum tumor was associated with significantly lower odds of sensory disturbances at last follow-up. CONCLUSIONS: The authors' data demonstrate that tumor location significantly influences symptom presentation, functional improvement over time, and overall outcomes, highlighting the importance of location-based stratification in future research and treatment strategies.

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