scholarly journals Extramedullary Conus Ependymoma Involving a Lumbar Nerve Root with Filum Terminale Attachment

2015 ◽  
Vol 8 ◽  
pp. CCRep.S24719 ◽  
Author(s):  
Takashi Moriwaki ◽  
Koichi Iwatsuki ◽  
Yu-ichiro Ohnishi ◽  
Koshi Ninomiya ◽  
Toshiki Yoshimine
Keyword(s):  
Nerve Root ◽  
Histopathological Examination ◽  
Conus Medullaris ◽  
Neurological Deficits ◽  
Myxopapillary Ependymoma ◽  
Filum Terminale ◽  
Intramedullary Tumors ◽  
Who Grade ◽  
Lumbar Nerve Root ◽  
Thoracic Cord

Purpose In the current report, we describe a case of an extramedullary ependymoma involving a lumbar nerve root near conus medullaris. Spinal ependymomas commonly present as intramedullary tumors in the cervical or thoracic cord or as tumors arising from the conus medullaris or the filum terminale. In this case, we showed an extramedullary conus ependymoma involving a lumbar nerve root with filum terminale attachment. Case Presentation A 69-year-old woman presented with lower back pain, but without sensory disturbance or motor weakness in her lower extremities. Clinical Assessment Magnetic resonance imaging revealed an intradural mass at T12–L1 at the conus medullaris, which was totally resected. Histopathology revealed a non-myxopapillary ependymoma (WHO grade 2). Postoperatively, the patient did well and displayed no neurological deficits. Moreover, no radiotherapy was required. Conclusions This report documented a rare case of intradural extramedullary ependymoma located at the conus medullaris, involving the lumbar nerve root, and attached to the filum terminale. Although extramedullary ependymomas at this region are more frequently classified as myxopapillary, histopathological examination revealed this tumor as a non-myxopapillary ependymoma.

scholarly journals Filum terminale paraganglioma with associated cyst: a case report

2018 ◽  
Vol 32 (2) ◽  
pp. 217-223 ◽  
Author(s):  
Danil Adam ◽  
Cristiana Moisescu ◽  
Dragos Iftimie ◽  
Gina Burdusa
Keyword(s):  
Histopathological Examination ◽  
Conus Medullaris ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Filum Terminale ◽  
Neurosurgical Department ◽  
Total Resection ◽  
Presenting Symptoms ◽  
Normal Ranges ◽  
Contrast Enhanced Ct

Abstract Background and importance: Paragangliomas are neuroendocrine tumors that occur most often within the adrenal glands. The most frequent extra-adrenal locations include the carotid body and the jugular bulb. Filum terminale paragangliomas are extremely rare, with just 33 cases reported to date. Imagistic appearance is similar with other types of intradural extramedullary tumors such as ependymomas and schwannomas. Histopathological examination is the only method of establishing a definitive diagnosis. They are classified as grade I WHO tumors with favorable prognosis in the case of total resection. Clinical presentation: A 46-year-old woman without any relevant medical history was admitted to our Neurosurgical Department, complaining of low back pain with bilateral sciatica. She presented no neurological deficits and routine blood tests, as well as heart rate and blood pressure, were within normal ranges. Lumbar spine MRI with gadolinium enhancement revealed an intradural tumor with irregular, well defined margins and intense homogeneous enhancement, located at the level of the L3 vertebra. It presented an unenhancing intradural cystic lesion that extended cranially up to the level of the L1 vertebra. The tumor and associated cyst were completely resected through L2-L4 laminectomy. The tumor-cyst complex was attached, yet nonadherent to the conus medullaris and nerve roots, which allowed safe total removal. Histopathological examination was suggestive for paraganglioma, a diagnosis confirmed by immunohistochemistry that classified it as moderately differentiated, non-secreting type. Serum metanephrines subsequently determined were within normal ranges. Also, additional imagistic tests consisting of cervical and abdominal ultrasound and contrast enhanced CT scans did not detect any additional tumors. Postoperatively, the patient was neurologically intact, with complete remission of presenting symptoms at 3 months follow-up. Conclusion: Filum terminale paraganglioma is a rare diagnosis which is frequently overlooked. However, gross total resection, a common goal for all spinal tumors, can be curative in these particular cases.

Extramedullary Ependymoma Near the Conus Medullaris With Lumbar Nerve Root Attachment: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. E831-E834 ◽  
Author(s):  
Christopher M Bonfield ◽  
Devin Amin ◽  
Ronald L Hamilton ◽  
Peter C Gerszten
Keyword(s):  
Nerve Root ◽  
Spinal Cord Tumor ◽  
Cauda Equina ◽  
Compression Fracture ◽  
Conus Medullaris ◽  
Magnetic Resonance Images ◽  
World Health ◽  
Low Grade ◽  
Lumbar Nerve Root ◽  
Intradural Extramedullary

Abstract BACKGROUND AND IMPORTANCE: Ependymomas are the most common primary spinal cord tumor, most frequently located near the cauda equina and conus medullaris. We believe that this is the first reported case of a low-grade, nonmyxopapillary (World Health Organization grade 2), intradural, extramedullary ependymoma involving a spinal nerve root. CLINICAL PRESENTATION: An 87-year-old woman presented with a chief complaint of acute onset of severe right hip and lateral thigh pain without midline back pain. She had baseline chronic bladder dysfunction, which remained unchanged. Her physical examination was significant for 4/5 strength in her right hip flexion (possibly related to pain), and 5 beats of clonus bilaterally. She had no point tenderness at the level of her compression fracture. Computed tomography of the patient's lumbar spine revealed a well-corticated, chronic compression fracture of the L3 vertebral body. Magnetic resonance images demonstrated an ovoid-shaped, 1.5 × 1-cm, well-circumscribed, intradural, extramedullary lesion at the conus medullaris. The patient underwent an L1-3 laminectomy with intradural resection of the mass, which was found to be intricately involved with a single nerve root. The nerve root was coagulated and sectioned, and a gross total resection of the tumor was achieved. CONCLUSION: The patient tolerated the procedure well, with no complications or any postoperative neurological deficit. Her right-sided pain immediately resolved after surgery. Her strength and ambulation were normal after surgery. No adjuvant radiotherapy was offered to the patient. This case illustrates a unique tumor presentation and the successful surgical treatment of the condition.

Concomitant Conus Medullaris Ependymoma and Filum Terminale Lipoma: Case Report

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. E1214-E1214 ◽  
Author(s):  
Gary L. Gallia ◽  
Peter C. Burger ◽  
Ian Suk ◽  
Carlos A. Bagley ◽  
Jean-Paul Wolinsky ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Bladder Dysfunction ◽  
Histopathological Examination ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Low Back ◽  
Filum Terminale ◽  
Resonance Imaging ◽  
Radiographic Findings ◽  
Bowel And Bladder Dysfunction

Abstract OBJECTIVE: Ependymomas of the conus medullaris-cauda equina-filum terminale region are typically solitary lesions. In this report, we describe the clinical presentation, radiographic findings, operative details, and pathological features of a patient with a conus medullaris ependymoma and a filum terminale lipoma. CLINICAL PRESENTATION: A 40-year-old woman presented with increasing low back pain and bowel and bladder dysfunction. Magnetic resonance imaging revealed a partially cystic enhancing lesion at the conus medullaris and a T1-weighted hyperintense mass within the filum terminale. INTERVENTION: An L2-L3 laminotomy/laminoplasty was performed for gross total resection of the mass. Histopathological examination demonstrated a conus medullaris ependymoma and filum terminale lipoma. The patient experienced complete resolution of her preoperative symptoms. CONCLUSION: Spinal cord ependymomas are almost exclusively single lesions and their coexistence with other pathological entities is rare. In this report, we describe a patient with a concomitant conus medullaris ependymoma and filum terminale lipoma.

Primary Myxopapillary Ependymoma of the Medulla

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. E1208-E1209 ◽  
Author(s):  
Michael L. DiLuna ◽  
Gillian H. Levy ◽  
Shreya Sood ◽  
Charles C. Duncan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Fourth Ventricle ◽  
Clinical Presentation ◽  
Conus Medullaris ◽  
Myxopapillary Ependymoma ◽  
Filum Terminale ◽  
Resonance Imaging ◽  
Total Resection ◽  
Suboccipital Craniotomy ◽  
History Of

Abstract OBJECTIVE Myxopapillary ependymoma is a subclassification of ependymoma that is thought to be nearly exclusive to the conus medullaris or filum terminale. Primary intracerebral or brainstem myxopapillary ependymomas are rare. CLINICAL PRESENTATION An 8-year-old child presented with a 5-month history of nausea and vomiting and a 1-week history of headache. Magnetic resonance imaging revealed a nodular mass in the medulla with an associated cyst extending into the fourth ventricle. INTERVENTION A suboccipital craniotomy was performed, and a gross total resection of the lesion and cyst was achieved. Histological examination confirmed the diagnosis of myxopapillary ependymoma. A discussion of other reported cases of extraspinal myxopapillary ependymomas is presented. CONCLUSION This is the first report of a case of myxopapillary ependymoma, confirmed by histology, in the medulla. Although rare, myxopapillary ependymomas outside of the filum terminale do exist.

Myxopapillary Ependymoma and Fatty Filum in an Adult with Tethered Cord Syndrome: A Shared Embryological Lesion? Case Report

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. E373-E373 ◽  
Author(s):  
D Cory Adamson ◽  
Thomas J. Cummings ◽  
Allan H. Friedman
Keyword(s):  
Unusual Case ◽  
Histopathological Examination ◽  
Tethered Cord ◽  
Conus Medullaris ◽  
Tethered Cord Syndrome ◽  
Myxopapillary Ependymoma ◽  
Low Back ◽  
Appropriate Treatment ◽  
Causative Relationship ◽  
Leg Weakness

ABSTRACT OBJECTIVE AND IMPORTANCE: Myxopapillary ependymoma and fatty fila are traditionally thought to arise via completely different pathophysiologies. Recognition of these distinct pathologies in the same patient is important for appropriate treatment and prognosis. CLINICAL PRESENTATION: A 28-year-old woman presented with low back pain, bilateral leg radiculopathies, and mild leg weakness suggestive of tethered cord syndrome. Magnetic resonance imaging revealed lesions in the area of the conus medullaris consistent with a myxopapillary ependymoma and fatty filum. INTERVENTION: Under the surveillance of intraoperative electromyographic monitoring, the patient underwent an L4–S2 laminectomy for transection of the fatty filum and gross total resection of the mass. Histopathological examination confirmed the presence of these two distinct pathologies. CONCLUSION: We report an unusual case of a myxopapillary ependymoma coexisting with a fatty filum in an adult patient. To the best of our knowledge, this association has not yet been reported. This raises the interesting question of a possible associative or causative relationship between these distinct pathologies, which have traditionally been thought to arise from different mechanisms.

Intradural extramedullary non-myxopapillary ependymoma with a lumbar nerve root involvement in a Japanese man

2016 ◽  
Vol 16 (8) ◽  
pp. e535-e536 ◽  
Author(s):  
Haruki Funao ◽  
Rie Irie ◽  
Kenshi Daimon ◽  
Norihiro Isogai ◽  
Hitoshi Sugiura ◽  
...  
Keyword(s):  
Nerve Root ◽  
Myxopapillary Ependymoma ◽  
Lumbar Nerve Root ◽  
Intradural Extramedullary ◽  
Nerve Root Involvement

scholarly journals Intradural Extramedullary Epidermoid Cyst at the Conus Medullaris Level with Thoracic Syringomyelia: A Case Report

2019 ◽  
Vol 62 (1) ◽  
pp. 39-42
Author(s):  
Bekir Akgun ◽  
Ahmet Cemil Ergun ◽  
Ibrahim Hanifi Ozercan ◽  
Selman Kok
Keyword(s):  
Epidermoid Cyst ◽  
Histopathological Examination ◽  
Conus Medullaris ◽  
Treatment Modalities ◽  
Benign Tumors ◽  
Resonance Imaging ◽  
Intramedullary Tumors ◽  
Epidermoid Cysts ◽  
Intradural Extramedullary ◽  
Magnetic Resonance Imaging Mri

Spinal epidermoid cysts are benign tumors. Syringomyelia secondary to intramedullary tumors are frequently observed. However, the association between syringomyelia and spinal intradural extramedullary epidermoid cyst in the conus medullaris region is extremely rare. We present the case of a 3-year-old male who was admitted with paraparesis and urinary retention. Magnetic resonance imaging (MRI) of the spine demonstrated intradural extramedullary lesion, compatible with epidermoid cyst, that at the conus medullaris level and a large syringomyelia extending from T4 to L1 vertebrae. Total microsurgical excision of the cyst was performed. No additional drainage was carried out for the syringomyelic cavity. Histopathological examination verified the diagnosis of the epidermoid cyst. Total excision of the cyst and disappearance of the syringomyelia were observed on MRI at 15 days postoperatively. We have clarified the etiology, clinical, histopathological and radiological features, differential diagnosis, and treatment modalities of spinal epidermoid cysts. In addition, we have discussed the possible mechanisms of syringomyelia formation in spinal intradural lesions.

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