{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:19:55Z","timestamp":1787617195375,"version":"build-2736575974"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Myxopapillary ependymomas (MPEs) are low-grade, well-circumscribed tumors that often involve the conus medullaris, cauda equina, or filum terminale. They account for up to 5% of all tumors of the spine and 13% of spinal ependymomas, with a peak incidence between 30 and 50 years of age. Because of the rarity of MPEs, their clinical course and optimal management strategy are not well defined, and long-term outcomes remain difficult to predict. The objective of this study was to review long-term clinical outcomes of spinal MPEs and identify factors that may predict tumor resectability and recurrence.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Pathologically confirmed cases of MPE at the authors\u2019 institution were identified and medical records were reviewed. Demographics, clinical presentation, imaging characteristics, surgical technique, follow-up, and outcome data were noted. Two groups of patients\u2014those who underwent gross-total resection (GTR) and those who underwent subtotal resection (STR)\u2014were compared using the Mann-Whitney U-test for continuous and ordinal variables and the Fisher exact test for categorical variables. Differences were considered statistically significant at p \u2264 0.05.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Twenty-eight patients were identified, with a median age of 43 years at the index surgery. The median postoperative follow-up duration was 107 months (range 5\u2013372 months). All patients presented with pain. Other common presenting symptoms were weakness (25.0%), sphincter disturbance (21.4%), and numbness (14.3%). GTR was achieved in 19 patients (68%) and STR in 9 (32%). Preoperative weakness and involvement of the sacral spinal canal were more common in the STR group. Tumors were larger and spanned more spinal levels in the STR group compared with the GTR cohort. Postoperative modified McCormick Scale grades were significantly higher in the STR cohort compared with the GTR group (p = 0.00175). Seven of the 9 STR patients (77.8%) underwent reoperation for recurrence at a median of 32 months from the index operation, while no patients required reoperation after GTR, for an overall reoperation rate of 25%.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Findings of this study emphasize the importance of tumor size and location\u2014particularly involvement of the sacral canal\u2014in determining resectability. Reoperation for recurrence was necessary in 78% of patients with subtotally resected tumors; none of the patients who underwent GTR required reoperation. Most patients had stable neurological status postoperatively.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.5.spine23433","type":"journal-article","created":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T07:32:37Z","timestamp":1688196757000},"page":"548-556","source":"Crossref","is-referenced-by-count":4,"title":["Surgical outcomes and risk factors for recurrence of myxopapillary ependymoma: a single-center experience"],"prefix":"10.3171","volume":"39","author":[{"given":"Mark C.","family":"Dougherty","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mani Ratnesh S.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahom","family":"Teferi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Noeller","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clayton L.","family":"Rosinski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold H.","family":"Menezes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirill V.","family":"Nourski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick W.","family":"Hitchon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","first-page":"991","article-title":"Primary tumors of the spinal cord and intradural filum terminale","volume":"3","author":"Kernohan JW","year":"1932","unstructured":"Kernohan JW. Primary tumors of the spinal cord and intradural filum terminale. In: Penfield W. Cytology and Cellular Pathology of the Nervous System. Vol 3. PB Hoeber;1932:991-1025."},{"key":"b2","article-title":"Myxopapillary ependymoma","author":"Limaiem F","year":"2023","unstructured":"Limaiem F, Das JM. Myxopapillary ependymoma. In: StatPearls [Internet]. StatPearls Publishing; 2023."},{"issue":"4","key":"b3","series-title":"J Neurosurg Spine","first-page":"471","article-title":"Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children: a systematic review","volume":"19","author":"Feldman WB","year":"2013","unstructured":"Feldman WB, Clark AJ, Safaee M, Ames CP, Parsa AT. Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children: a systematic review. J Neurosurg Spine. 2013;19(4):471\u2013476."},{"issue":"8","key":"b4","series-title":"Neuro Oncol","first-page":"1231","article-title":"The 2021 WHO Classification of Tumors of the Central Nervous System: a summary","volume":"23","author":"Louis DN","year":"2021","unstructured":"Louis DN, Perry A, Wesseling P,  The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021;23(8):1231\u20131251."},{"issue":"4","key":"b5","series-title":"Neuro Oncol","first-page":"588","article-title":"Long-term outcome of patients with spinal myxopapillary ependymoma: treatment results from the MD Anderson Cancer Center and institutions from the Rare Cancer Network","volume":"17","author":"Weber DC","year":"2015","unstructured":"Weber DC, Wang Y, Miller R,  Long-term outcome of patients with spinal myxopapillary ependymoma: treatment results from the MD Anderson Cancer Center and institutions from the Rare Cancer Network. Neuro Oncol. 2015;17(4):588\u2013595."},{"issue":"3","key":"b6","series-title":"Neurochirurgie","first-page":"273","article-title":"Prognostic factors for progression-free survival of the filum terminale ependymomas in adults","volume":"68","author":"Dauleac C","year":"2022","unstructured":"Dauleac C, Manet R, Meyronet D,  Prognostic factors for progression-free survival of the filum terminale ependymomas in adults. Neurochirurgie. 2022;68(3):273\u2013279."},{"issue":"3","key":"b7","series-title":"J Neurosurg Spine","first-page":"452","article-title":"Cauda equina ependymomas: surgical treatment and long-term outcomes in a series of 125 patients","volume":"36","author":"Marchesini N","year":"2022","unstructured":"Marchesini N, Tommasi N, Faccioli F, Pinna G, Sala F. Cauda equina ependymomas: surgical treatment and long-term outcomes in a series of 125 patients. J Neurosurg Spine. 2022;36(3):452\u2013463."},{"key":"b8","series-title":"Surg Neurol Int","first-page":"429","article-title":"Myxopapillary ependymomas; proximity to the conus and its effect on presentation and outcomes","volume":"12","author":"Helal A","year":"2021","unstructured":"Helal A, Mikula AL, Laack NN, Krauss WE, Clarke MJ. Myxopapillary ependymomas; proximity to the conus and its effect on presentation and outcomes. Surg Neurol Int. 2021;12:429."},{"issue":"3","key":"b9","series-title":"J Neurooncol","first-page":"491","article-title":"Clinical characteristics and long-term surgical outcome of spinal myxopapillary ependymoma: a French cohort of 101 patients","volume":"152","author":"Montero AS","year":"2021","unstructured":"Montero AS, Tran S, Amelot A,  Clinical characteristics and long-term surgical outcome of spinal myxopapillary ependymoma: a French cohort of 101 patients. J Neurooncol. 2021;152(3):491\u2013499."},{"key":"b10","series-title":"World Neurosurg","first-page":"e1105","article-title":"Clinical features, treatments, and prognostic factors of spinal myxopapillary ependymoma","volume":"149","author":"Fan F","year":"2021","unstructured":"Fan F, Zhou J, Zheng Y, Liu S, Tang Z, Wang Y. Clinical features, treatments, and prognostic factors of spinal myxopapillary ependymoma. World Neurosurg. 2021;149:e1105\u2013e1111."},{"issue":"2","key":"b11","series-title":"J Neurooncol","first-page":"241","article-title":"Long-term outcomes of spinal ependymomas: an institutional experience of more than 60 cases","volume":"151","author":"Savoor R","year":"2021","unstructured":"Savoor R, Sita TL, Dahdaleh NS,  Long-term outcomes of spinal ependymomas: an institutional experience of more than 60 cases. J Neurooncol. 2021;151(2):241\u2013247."},{"key":"b12","series-title":"World Neurosurg","first-page":"e245","article-title":"Long-term surgical resection outcomes of pediatric myxopapillary ependymoma: experience of two centers and brief literature review","volume":"136","author":"Abdallah A","year":"2020","unstructured":"Abdallah A, Emel E, G\u00fcnd\u00fcz HB, Sofuo\u011flu \u00d6E, Asilt\u00fcrk M, Abdallah BG. Long-term surgical resection outcomes of pediatric myxopapillary ependymoma: experience of two centers and brief literature review. World Neurosurg. 2020;136:e245\u2013e261."},{"issue":"2","key":"b13","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Outcomes following myxopapillary ependymoma resection: the importance of capsule integrity","volume":"39","author":"Abdulaziz M","year":"2015","unstructured":"Abdulaziz M, Mallory GW, Bydon M,  Outcomes following myxopapillary ependymoma resection: the importance of capsule integrity. Neurosurg Focus. 2015;39(2):E8."},{"issue":"9","key":"b14","series-title":"Neurol Res","first-page":"774","article-title":"Management of myxopapillary ependymoma: a retrospective study from three institutions","volume":"44","author":"Abdallah A","year":"2022","unstructured":"Abdallah A, Balo\u011flu G, G\u00fcler Abdallah B, G\u00fcnda\u011f Papaker M, Rakip U. Management of myxopapillary ependymoma: a retrospective study from three institutions. Neurol Res. 2022;44(9):774\u2013785."},{"issue":"2","key":"b15","series-title":"J Neurooncol","first-page":"177","article-title":"Spinal myxopapillary ependymoma outcomes in patients treated with surgery and radiotherapy at M.D. Anderson Cancer Center","volume":"80","author":"Akyurek S","year":"2006","unstructured":"Akyurek S, Chang EL, Yu TK,  Spinal myxopapillary ependymoma outcomes in patients treated with surgery and radiotherapy at M.D. Anderson Cancer Center. J Neurooncol. 2006;80(2):177\u2013183."},{"issue":"4","key":"b16","series-title":"Cancer","first-page":"883","article-title":"Myxopapillary ependymoma. A clinicopathologic and immunocytochemical study of 77 cases","volume":"56","author":"Sonneland PR","year":"1985","unstructured":"Sonneland PR, Scheithauer BW, Onofrio BM. Myxopapillary ependymoma. A clinicopathologic and immunocytochemical study of 77 cases. Cancer. 1985;56(4):883\u2013893."},{"issue":"2","key":"b17","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Spinal ependymomas. Part 2: Ependymomas of the filum terminale","volume":"39","author":"Klekamp J","year":"2015","unstructured":"Klekamp J. Spinal ependymomas. Part 2: Ependymomas of the filum terminale. Neurosurg Focus. 2015;39(2):E7."},{"issue":"2","key":"b18","series-title":"J Neurosurg Spine","first-page":"201","article-title":"Metastases of spinal myxopapillary ependymoma: unique characteristics and clinical management","volume":"28","author":"Kraetzig T","year":"2018","unstructured":"Kraetzig T, McLaughlin L, Bilsky MH, Laufer I. Metastases of spinal myxopapillary ependymoma: unique characteristics and clinical management. J Neurosurg Spine. 2018;28(2):201\u2013208."},{"issue":"2","key":"b19","series-title":"CNS Neurosci Ther","first-page":"131","article-title":"Surgery for primary filum terminale ependymomas: outcome and prognostic factors","volume":"20","author":"Xie TH","year":"2014","unstructured":"Xie TH, Chen XZ, Qian J,  Surgery for primary filum terminale ependymomas: outcome and prognostic factors. CNS Neurosci Ther. 2014;20(2):131\u2013139."},{"issue":"21","key":"b20","series-title":"Spine (Phila Pa 1976)","first-page":"E756","article-title":"Long-term surgical outcomes for myxopapillary ependymomas of the cauda equina","volume":"34","author":"Nakamura M","year":"2009","unstructured":"Nakamura M, Ishii K, Watanabe K,  Long-term surgical outcomes for myxopapillary ependymomas of the cauda equina. Spine (Phila Pa 1976). 2009;34(21):E756\u2013E760."},{"issue":"1","key":"b21","series-title":"Pediatr Neurosurg","first-page":"30","article-title":"Pediatric low-grade and ependymal spinal cord tumors","volume":"32","author":"Merchant TE","year":"2000","unstructured":"Merchant TE, Kiehna EN, Thompson SJ, Heideman R, Sanford RA, Kun LE. Pediatric low-grade and ependymal spinal cord tumors. Pediatr Neurosurg. 2000;32(1):30\u201336."},{"issue":"4","key":"b22","series-title":"Pediatr Blood Cancer","first-page":"639","article-title":"Adjuvant radiotherapy in the treatment of pediatric myxopapillary ependymomas","volume":"55","author":"Al-Halabi H","year":"2010","unstructured":"Al-Halabi H, Montes JL, Atkinson J, Farmer JP, Freeman CR. Adjuvant radiotherapy in the treatment of pediatric myxopapillary ependymomas. Pediatr Blood Cancer. 2010;55(4):639\u2013643."},{"issue":"3","key":"b23","series-title":"J Neurosurg Spine","first-page":"392","article-title":"Analyzing the role of adjuvant or salvage radiotherapy for spinal myxopapillary ependymomas","volume":"33","author":"Kotecha R","year":"2020","unstructured":"Kotecha R, Tom MC, Naik M,  Analyzing the role of adjuvant or salvage radiotherapy for spinal myxopapillary ependymomas. J Neurosurg Spine. 2020;33(3):392\u2013397."},{"issue":"1","key":"b24","series-title":"Oncol Rev","first-page":"518","article-title":"Adjunctive treatment of myxopapillary ependymoma","volume":"15","author":"Jahanbakhshi A","year":"2021","unstructured":"Jahanbakhshi A, Najafi M, Jafari F,  Adjunctive treatment of myxopapillary ependymoma. Oncol Rev. 2021;15(1):518."},{"issue":"1","key":"b25","series-title":"Med Pediatr Oncol","first-page":"67","article-title":"Experience with tamoxifen\/etoposide in the treatment of a child with myxopapillary ependymoma","volume":"37","author":"Madden JR","year":"2001","unstructured":"Madden JR, Fenton LZ, Weil M, Winston KR, Partington M, Foreman NK. Experience with tamoxifen\/etoposide in the treatment of a child with myxopapillary ependymoma. Med Pediatr Oncol. 2001;37(1):67\u201369."},{"issue":"suppl 3","key":"b26","series-title":"Eur Spine J","first-page":"421","article-title":"Remarkable efficacy of temozolomide for relapsed spinal myxopapillary ependymoma with multiple recurrence and cerebrospinal dissemination: a case report and literature review","volume":"27","author":"Fujiwara Y","year":"2018","unstructured":"Fujiwara Y, Manabe H, Izumi B, Shima T, Adachi N. Remarkable efficacy of temozolomide for relapsed spinal myxopapillary ependymoma with multiple recurrence and cerebrospinal dissemination: a case report and literature review. Eur Spine J. 2018;27(suppl 3):421-425."},{"key":"b27","series-title":"Rare Tumors","first-page":"20363613231152333","article-title":"PARP inhibition utilized in combination therapy with olaparib-temozolomide to achieve disease stabilization in a rare case of BRCA1-mutant, metastatic myxopapillary ependymoma","volume":"15","author":"Mahalingam P","year":"2023","unstructured":"Mahalingam P, Smith S, Lopez J,  PARP inhibition utilized in combination therapy with olaparib-temozolomide to achieve disease stabilization in a rare case of BRCA1-mutant, metastatic myxopapillary ependymoma. Rare Tumors. 2023;15:20363613231152333."},{"issue":"12","key":"b28","series-title":"BMJ Case Rep","first-page":"e236242","article-title":"Metastatic myxopapillary ependymoma treated with immunotherapy achieving durable response","volume":"13","author":"Tapia Rico G","year":"2020","unstructured":"Tapia Rico G, Townsend A, Price T, Patterson K. Metastatic myxopapillary ependymoma treated with immunotherapy achieving durable response. BMJ Case Rep. 2020;13(12):e236242."},{"issue":"15","key":"b29","series-title":"Spine (Phila Pa 1976)","first-page":"1619","article-title":"Spinal myxopapillary ependymoma: neurological deterioration in patients treated with surgery","volume":"34","author":"Sakai Y","year":"2009","unstructured":"Sakai Y, Matsuyama Y, Katayama Y,  Spinal myxopapillary ependymoma: neurological deterioration in patients treated with surgery. Spine (Phila Pa 1976). 2009;34(15):1619\u20131624."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/39\/4\/article-p548.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/39\/4\/article-p548.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/39\/4\/article-p548.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:14:39Z","timestamp":1733490879000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/39\/4\/article-p548.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,1]]},"references-count":29,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2023.5.spine23433","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2023,10,1]]}}}