Medcyclopaedia Home E-learningLibraryLexical IndexLexical TopicsGlossaryFace-a-CaseSpinal CordAcute disseminated encephalomyelitis (ADEM)Acute ischemic lesionAstrocytoma, case 1Astrocytoma, case 2Astrocytoma, case 3Astrocytoma, case 4Astrocytoma, case 5Astrocytoma, case 6Astrocytoma grade IIAstrocytoma, surgeryAVM, case 1AVM, case 2AVM, dural fistulaeCavernoma, case 1Cavernoma, case 2Cavernoma, case 3Cavernoma, case 4Cavernous angiomaDural fistula, case 1Dural fistula, case 2Dural fistula, case 3Ependymoma, case 1Ependymoma, case 2Ependymoma, case 3Ependymoma, case 4Ependymoma, case 5Ependymoma grade II, case 1Ependymoma grade II, case 2Ependymoma grade II, case 3Ependymoma grade II, case 4Ependymoma grade II, case 5Ependymoma grade II, case 6Ependymoma grade II, case 7Ependymoma grade II, case 8Ependymoma grade II, case 2Ependymoma grade II, case 10Epidermoid cyst, spinalGangliogliomaGlioblastoma grade IVHemangioblastoma, case 1Hemangioblastoma, case 2Hemangioblastoma, case 3Hemangioblastoma, case 4Hemangioblastoma, case 5Hemangioblastoma, surgeryHerpes myelitisHydatid cyst, spinal cordHydrosyringomyelia, case 1Hydrosyringomyelia, case 2Hydrosyringomyelia, case 3Hydrosyringomyelia, case 4Intramedullary- inflammatory lesionIntramedullary metastasisIschemic lesion in systemic lupus erythematosusLipoma, case 2LymphomaMetastasis, case 1Metastasis, case 2Metastasis, case 3Metastasis, case 4Multiple sclerosis, case 1Multiple sclerosis, case 2Multiple sclerosis, case 3Multiple sclerosis, case 4Multiple sclerosis, case 5Multiple sclerosis, case 6Multiple sclerosis, case 7Myxopapillary ependymoma grade I (WHO)Myxopapillary ependymoma of the conus, case 1Myxopapillary ependymoma of the conus, case 2Myxopapillary ependymomaof the conus, case 1Neurofibromatosis type IIOptic neuritis, Devic's syndrome in disseminated lupus erythematosus (SLE)Paraneoplastic encephalomyelitisPost-vaccination myelitisSarcoidosis, case 1Sarcoidosis, case 2SchwannomaSpinal cord schistosomiasisSpinal cord tuberculosisSubependymal ependymomaTancytic ependymoma grade II, case 1Tanycytic ependymoma grade II, case 2Tanycytic ependymoma grade II, case 3Transverse myelitis of unknown etiologyCerebral TumorsMR Neuro AngiographyTextbook of RadiologyTextbook of Radiology (e-paper)Medical Imaging Made EasyDownloadsMedcyclOasisAbout MedcyclopaediaContact Us
MedcycloPoll
Did you get the help you required from Medcyclopaedia™ during today's visit?
Yes
 
 (84.5%)
No
 
 (10.9%)
Undecided
 
 (4.6%)
You must be logged on to vote.
Please log in or register.
 
 
 

Ependymoma, case 3

 

Clinical history
This 57-year-old female experienced six months of cervical pain radiating into both arms.
At clinical examination, radicular pain in both arms was noted as well as a sensory deficit starting at the C4 level.
Degree of disability: McCormick I.

Pre-operative MRI (March 1989)
Images 1 - 3: Sagittal T1WI. Spinal cord enlargement is seen from the craniocervical junction to the C7-T1 level, with multiple cystic components. Note also a solid mass from the C5-C6 to C6-C7 level, iso-intense to the spinal cord.
Images 4 - 6: Sagittal T2WI. These images show a cystic tumor from the C3-C4 level to C7, with a hypointense nodule at the C5 and C6 level. The intratumoral cysts are hyperintense to CSF, due to high protein content. Note the slightly hypointense rim at the upper and lower pole of the tumor, corresponding to hemosiderin and ferritin deposits. Furthermore, note also the presence of a large associated intramedullary cyst in the upper cervical spinal cord and of a bulbar cyst. The signal behavior of these cystic components is identical to CSF.
Images 7 - 8: Sagittal Gd T1WI and image 9: Coronal Gd T1WI: Note the intense enhancement of the solid part of the tumor, with absence of enhancement of the cyst walls.

Surgery
Video 1: ependymoma
At surgery, an occipital craniectomy was performed as well as a C1-T1 laminectomy. An easy cleavage plane between tumor and normal cord was found and total tumor resection was achieved, confirming the presence of a cystic tumor without gross hemorrhage.

Stage 1: Identification and opening of the midline.
Stage 2: Opening of the inferior cyst and identification of the tumor bulging into the cyst.
Stage 3: Opening of the superior satellite cyst.
Stage 4: Low magnification view of the tumor.
Stage 5: Dissection of the tumor.
Stage 6: The tumor is completely removed.

Histology:
Ependymoma grade II.

Follow-up MRI (September 1989)
Image 10: Sagittal T1WI. Cervical spinal cord atrophy is identified, as is a cystic lesion at the C1-C3 level.
Image 11: Sagittal Gd T1WI. No enhancement is seen after Gd injection.
Hypointense foci are seen at the C3 and C7 level, corresponding to hemosiderin and ferritin deposits.

Second follow-up MRI (November 1989)
Images 12 - 14: Sagittal T1WI. The cyst is still present. Cervical kyphosis has developed.
Images 15 - 17: Sagittal Gd T1WI. No enhancement after Gd injection.

Third follow-up MRI (April 1991)
Images 18 - 20: Sagittal T1WI. Partial collapse of the cyst at the C1-C3 level. Loss of height of the anterior part of the C4 vertebral body, due to compression fracture.
Image 21: Sagittal T2WI.
Images 22 - 24: Sagittal Gd T1WI.
Images 25 - 26: Axial T2WI.
No evidence of tumor recurrence in images 21 - 26.

Fourth follow-up MRI (April 1992)
Images 27 - 28: Sagittal T1WI and T2WI. Stability of the intramedullary C2-C3 cyst. Acquired fusion of the C3-C4 vertebral bodies.
Image 29: Sagittal Gd T1WI. No pathological contrast enhancement.

Post-operative clinical course
The clinical symptoms were unchanged immediately following surgery. The McCormick grade remained type I.
The posterior cord sensory deficit remained unchanged (C4 level) 3 and 12 months after surgery. Radicular pain persisted in the left arm one year after surgery. No spasticity was observed. A post-operative kyphosis eventually developed.
Clinically, the patient remains stable after 5 years of follow-up.

Search also:
- Ependymoma

 

The ESNR CD-Rom Series

To view high resolution images,
please register first.

Click  here to register.

Already registered? Enter your e-mail in the window below.
Re-register

Fig. 1

Ependymoma, case 3, Fig. 1
Ependymoma, case 3, Fig. 2
Ependymoma, case 3, Fig. 3
Ependymoma, case 3, Fig. 4
Ependymoma, case 3, Fig. 5
Ependymoma, case 3, Fig. 6
Ependymoma, case 3, Fig. 7
Ependymoma, case 3, Fig. 8
Ependymoma, case 3, Fig. 9
Ependymoma, case 3, Fig. 10
Ependymoma, case 3, Fig. 11
Ependymoma, case 3, Fig. 12
Ependymoma, case 3, Fig. 13
Ependymoma, case 3, Fig. 14
Ependymoma, case 3, Fig. 15
Ependymoma, case 3, Fig. 16
Ependymoma, case 3, Fig. 17
Ependymoma, case 3, Fig. 18
Ependymoma, case 3, Fig. 19
Ependymoma, case 3, Fig. 20
Ependymoma, case 3, Fig. 21
Ependymoma, case 3, Fig. 22
Ependymoma, case 3, Fig. 23
Ependymoma, case 3, Fig. 24
Ependymoma, case 3, Fig. 25
Ependymoma, case 3, Fig. 26
Ependymoma, case 3, Fig. 27
Ependymoma, case 3, Fig. 28
Ependymoma, case 3, Fig. 29