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

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 followup 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.