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

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

Fnu Ruchika, A Karim Ahmed, Abdel-Hameed Al-Mistarehi, Yuanxuan Xia, Joseph Rajasekaran, Emre Derin, Chetan Bettegowda, Daniel M Sciubba, Sheng-Fu Larry Lo, Ali Bydon, …
Journal of neurosurgery. Spine, v 44(2), pp 262-271
24 Oct 2025
DOI: https://doi.org/10.3171/2025.6.SPINE25209
PMID: 41135111

Abstract

Adult Aged Cauda Equina - pathology Cauda Equina - surgery Cervical Vertebrae - surgery Ependymoma - diagnosis Ependymoma - pathology Ependymoma - surgery Female Follow-Up Studies Humans Male Middle Aged Retrospective Studies Spinal Cord Neoplasms - diagnosis Spinal Cord Neoplasms - pathology Spinal Cord Neoplasms - surgery Thoracic Vertebrae - surgery Treatment Outcome Young Adult
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. 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. 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. 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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