# An opportunity for fertility preservation in neurosurgical spinal ependymoma patients: a single center review

## TL;DR

This study finds that fertility counseling is rarely offered to spinal ependymoma patients, highlighting a missed opportunity for preserving fertility in neurosurgical oncology care.

## Contribution

The study reveals a critical gap in fertility preservation counseling for spinal ependymoma patients within a single neurosurgery department.

## Key findings

- Only one out of 11 eligible patients received fertility preservation counseling or referrals.
- Neurosurgical oncology may be missing a key opportunity to address fertility concerns in cancer care.
- Protocols for fertility counseling should be integrated into neurosurgical oncology practice.

## Abstract

Spinal ependymomas are intradural intramedullary tumors that present frequently in adults with a bimodal peak at 25–29 years and again at 45–59 years. The risk of progressive neurological deficit in these patients creates the need for surgical resection and radiation therapy. Myxopapillary ependymomas specifically occur at the conus medullaris within the lumbar spine, and these treatments can have a significant impact on patient fertility. However, recent reports illustrate that a vast majority of adults with cancer receive inadequate fertility preservation education, counseling, or resources, and providers tend to cite barriers such as lack of knowledge about fertility preservation options or referrals as well as discomfort with broaching the topic. This review aims to explore the extent to which fertility preservation counseling was offered by a neurosurgery department at a single institution to patients with ependymomas and the subsequent utilization of fertility preservation services. A retrospective review of our local spine tumor database from 2015 to 2025 identified 15 patients who underwent surgery for spinal ependymomas at Rhode Island Hospital. Patients who were outside of child-bearing years (<18 years to >44 years) were excluded (N = 4). Medical records were searched for references to fertility counseling within the notes as well as subsequent receipt of patient services. This cohort consisted of 3 female and 8 male patients with a median age of 42 years. Two patients underwent postoperative radiation treatment. Only one patient in the cohort received any type of fertility preservation counseling or discussion of fertility-related risks of treatment and was referred for sperm banking services. These results shed light on a gap in care regarding fertility in neurosurgical oncology. Previous research suggests that there are significant benefits of fertility preservation counseling and REI referral in every specialty that provides oncology care. This implies that, as a part of the oncological care team, neurosurgeons may be missing a critical opportunity to help their patients achieve goals that extend past their cancer journeys, and further development of protocols for fertility preservation counseling are needed in order for neurosurgeons to provide quality care beyond the doors of the operating room.