Intradural extramedullary ependymoma with spinal root attachment: a case report

Area of Science:

• Neurosurgery
• Neuropathology
• Spinal Oncology

Background:

• Intradural extramedullary (IDEM) spinal tumors are rare, comprising a small percentage of all spinal neoplasms.
• Ependymomas typically arise within the spinal cord parenchyma or filum terminale, with IDEM presentation being exceptionally uncommon.
• Spinal cord compression due to large tumors can lead to significant neurological deficits.

Purpose of the Study:

• To report a rare case of a large IDEM ependymoma with spinal root attachment.
• To highlight the diagnostic and surgical challenges associated with this rare tumor location.
• To discuss the favorable outcome following complete tumor resection.

Main Methods:

• A 36-year-old female patient with a year of shoulder pain and one month of leg weakness underwent magnetic resonance imaging (MRI).
• MRI revealed a large, heterogeneously enhancing fusiform mass at the C6-T4 level, causing spinal cord compression.
• Surgical exploration identified an encapsulated IDEM tumor with spinal root attachment, followed by complete resection and histopathological diagnosis.

Main Results:

• The resected tumor was histologically confirmed as ependymoma.
• The patient experienced complete resection of the IDEM ependymoma.
• At the 6-month follow-up, the patient demonstrated a favorable outcome with no evidence of tumor recurrence.

Conclusions:

• Intradural extramedullary ependymomas, though rare, should be considered in the differential diagnosis of spinal tumors causing cord compression.
• Complete surgical resection is crucial for achieving favorable outcomes in these cases.
• This case underscores the importance of thorough histopathological examination for accurate tumor classification and management planning.