Ependymoma grade II, case 2

Clinical history
20-year-old female.
This young patient complained exclusively of progressive severe cervicalgia as well as intercostal pain. Plain X-rays films show loss of normal cervical lordosis and straightening of cervical spine.

Neurological examination
Strictly normal without any sensory or motor deficit.

Preoperative MRI findings
Image 1: Sagittal T1WI. Straightening of the cervical spine and absence of normal lordosis is clearly shown. Moreover, there is an iso- to slightly hyperintense intramedullary lesion at C4-C7. Associated cystic components are seen both above and below this lesion.
Image 2: Sagittal T2 WI. The solid tumoral lesion is isointense to normal spinal cord. Both cystic components are hyperintense and isointense to CSF.
Image 3: Sagittal Gd T1WI. After Gadolinium injection, homogeneous enhancement is seen in the solid component. No contrast enhancement is observed at the periphery of the associated cystic components. The cystic components have signal behavior identical to CSF on all pulse sequences.
Image 4: Axial Gd T1WI. These axial images nicely confirm that the tumor is located strictly in the center of the medulla. The associated cyst is also strictly centrally located and corresponds to enlargement of the ependymal canal.

Surgery
Total removal of the tumor was achieved and control of somatosensory evoked potentials were preserved throughout operation.

Histology
Grade II ependymoma.

Postoperative neurologic examination
Showed sensorial ataxia due to the dissection at opening of the posterior sensory tracts. Long term prognosis was good. There was no motor deficit.

Image 5: Sagittal T1WI, image 6: sagittal Gd T1WI, image 7: sagittal T2WI. Immediate postoperative control examination shows that the associated cystic components are already reduced in size. Total resection of the tumor is confirmed. No contrast enhancement is seen after Gadolinium injection.

Follow-up clinical examination
Persistent sensory deficit and persistent thoracic pain were reported.
Eventually, the patient became pregnant and experienced normal delivery.

Search also:
- Ependymoma

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