The role of MRI patterns in predicting neurologic deficits in spinal ependymomas

Objective Spinal ependymomas are the most common intramedullary spinal cord tumors, with surgical resection being the primary treatment modality. This study aimed to evaluate the prognostic value of preoperative MRI features in predicting motor deficits in patients undergoing surgery for spinal ependymomas.

Methods We retrospectively analyzed 71 patients with histopathologically confirmed spinal ependymomas who underwent surgical resection between 2009 and 2021. Preoperative MRI features-including tumor volume, cystic components, syrinx formation, intratumoral hemorrhage, and longitudinal tumor extension-were assessed. Motor strength was recorded pre- and postoperatively. Statistical analysis included univariate comparisons and multivariate logistic regression to identify independent predictors of neurological deficits.

Results Preoperative motor weakness was significantly associated with syrinx formation (p = 0.012), intratumoral hemorrhage (p = 0.015), and greater tumor length (p = 0.037). Postoperative motor deterioration was significantly correlated with intratumoral hemorrhage (p = 0.025), increased tumor volume (p = 0.007), and longitudinal extension (p = 0.001). In multivariate analysis, the number of vertebral levels involved was the only independent predictor of postoperative motor weakness (OR = 1.737; 95% CI: 1.063-2.838; p = 0.028). No independent predictors were identified for preoperative weakness, although syrinx formation showed a trend toward significance.

Conclusion Preoperative MRI findings-particularly intratumoral hemorrhage, syrinx formation, and longitudinal extension-are associated with motor deficits in spinal ependymomas. However, only longitudinal tumor extension was an independent predictor of postoperative neurological deterioration. These findings highlight the importance of comprehensive radiological assessment in preoperative planning and risk stratification. Small sample size and short-term postoperative assessment represent important limitations of this study.