Due to the benign, slow-growing nature of intramedullary tumors, the mere presence of an ependymoma is not necessarily an indication for immediate treatment. Often these tumors are discovered incidentally (in passing) in patients without any symptoms. If the tumor is small and does not exert pressure on the surrounding spinal cord, it may simply be followed with annual MR imaging. Several years may pass before the tumor begins to put enough pressure on the spinal cord to necessitate treatment.
For larger tumors, or those tumors causing symptoms, treatment is recommended. Because these tumors are benign and slow-growing, microsurgical tumor removal is the treatment of choice for most patients. In microsurgical tumor removal, a surgeon uses a surgical microscope and very fine instruments to expose and remove the tumor.
Microsurgery to remove an ependymoma is performed under general anesthesia with the patient positioned face-down. Spinal cord function is carefully monitored throughout the procedure using precise electrophysiological techniques such as SSEP (somatosensory evoked potentials) and MEP (motor evoked potentials).
A laminectomy, or removal of a portion of the back of the spine, is performed to gain access to the spinal canal. The thin covering of the spinal canal known as the spinal dura is opened to expose the spinal cord. A thin opening in the back portion of the spinal cord is made to expose the tumor. Ependymomas are usually well defined and can be separated from the surrounding spinal cord using neurosurgical techniques. A laser or ultrasonic tool may be utilized.
In most patients, the tumor can be completely removed without substantially disturbing the function of the spinal cord. However, many patients may note some diminished sensation in the legs due to the opening of the spinal cord.
A more complete description and illustration of the surgical techniques are demonstrated in this video.
Watch Dr. McCormick perform the surgery in this video.
Microsurgical Resection of Intramedullary Spinal Cord Ependymoma
|