GIANT EPENDYMOMAS OF THE CAUDA-EQUINA - LONG-TERM FOLLOW-UP IN 7 PATIENTS

Seven cases of giant ependymomas of cauda equina, extending from the c onus medullaris to the sacrum, are reported. Mean age of the patients was 36 years. The initial symptoms were not specific, including low ba ck pain and radiculalgias. However, in two cases, the clinical present ation was related to hydrocephalus. At the time of the operation, 6 pa tients presented with pain, weakness and sphincter dysfunction. The di agnosis of tumor was made after myelogram in all cases. Metrizamide en hanced CT scan has been performed in one case. None patient had preope rative magnetic resonance imaging (MRI) but MRI allowed the follow up in 5 patients and detection of local and remote recurrences in 4 cases . All the tumors were attached to the filum terminale, and unless exte nded from L2 to S1. Pathologically, 3 patients had tumors classified a s myxopapillary and 4 of the cellular type. Two patients had gross tot al resection of the tumor at the initial operation. Five patients had initial biopsy to make a diagnosis and required subsequent surgery for radical excision after an average of 16,8 months. Radiation therapy h as been performed in 1 case after biopsy, in 1 case after total resect ion (grade III) and in 2 cases after recurrences. Three patients died 1 year, 5 years, 12 years post-operatively. Among these 3 patients, 2 had recurrences. Four patients are alive. One patient has no recurrenc e 5 years after initial surgery. Another patient remains symptom free 7 years after surgery but MRI showed a local recurrence. The last two patients present recurrences 7 years and 8 years after surgery. These recurrences have been treated by surgical removal. These 4 patients ha ve neurological deficits such as weakness of lower limbs and sphincter dysfunction. Results are discussed in comparison with those of cauda equina ependymomas whatever be the size. The evolution of giant ependy momas is less satisfactory in relation to the high rate of recurrences . Initial radical surgery seems to be the most important prognostic fa ctor.