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- Department of Neurosurgery, Hospital de Força Aérea do Galeão, Brazil.
- Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil.
Correspondence Address:
Dan Zimelewicz Oberman, Department of Neurosurgery, Hospital de Força Aérea do Galeão, Rio de Janeiro, Brazil.
DOI:10.25259/SNI_698_2021
Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Dan Zimelewicz Oberman1, Raphael Machado2, Luiz Felipe Ribeiro2, Daniela de Oliveira Von Zuben2, Paulo Alves Bahia2, Hugo Corrêa Schiavini2, Ruy Monteiro2. Microsurgical resection of a giant cervico-medullary ependymoma: 2D-dimensional video. 30-Aug-2021;12:440
How to cite this URL: Dan Zimelewicz Oberman1, Raphael Machado2, Luiz Felipe Ribeiro2, Daniela de Oliveira Von Zuben2, Paulo Alves Bahia2, Hugo Corrêa Schiavini2, Ruy Monteiro2. Microsurgical resection of a giant cervico-medullary ependymoma: 2D-dimensional video. 30-Aug-2021;12:440. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11082
Date of Submission
15-Jul-2021
Date of Acceptance
28-Jul-2021
Date of Web Publication
30-Aug-2021
Abstract
Background: Ependymoma is a slowly growing benign neoplasm that constitutes 3–9% of all neuroepithelial spinal cord tumors.[
Case Description: A 23-year-old female presented with cervical pain and quadriparesis of 1-year’s duration. The MR with/without gadolinium showed a large intradural, intramedullary cervical spinal cord tumor that severely expanded the spinal cord. It contained a significant cystic component, extending from the lower brain stem to the inferior aspect of C7. The lesion was hyperintense on T1 and T2 sequences and demonstrated minimal contrast enhancement. Surgery warranted a posterior cranio-cervical midline approach consisting of a suboccipital craniectomy with laminotomy. The pathological diagnosis was consistent with an ependymoma (WHO I). Fifteen days postoperatively, the patient was discharged with a minimal residual quadriparesis that largely resolved within 6 postoperative months. Three months later, the MRI confirmed complete tumor removal of the lesion. Notably, longer-term follow-up is warranted before complete excision can be confirmed. If there is a recurrence, repeat resection versus stereotactic radiosurgery may be warranted.
Conclusion: This video highlights a safe and effective surgical technique for the resection of a giant cervicomedullary ependymoma.
Video 1
Annotations[1-4]
2:55 – Midline mielotomy. 3:27 – Beginning of tumor dissection. 4:14 – Ultrasonic debulking from brainstem. 4:57 – Tumor removal.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Video 1]-Available on:
www.surgicalneurologyint.com
References
1. Cappelletti M, Ruggeri AG, Iacopino G, Delfini R. Giant cell ependymoma of cervicomedullary junction: A case report of a long-term survivor and literature review. World Neurosurg. 2018. 116: 121-6
2. Ito T, Ozaki Y, Nakagawara J, Nakamura H, Tanaka S, Nagashima K. A case of cervicomedullary junction tanycytic ependymoma associated with marked cyst formation. Brain Tumor Pathol. 2005. 22: 29-33
3. Oh MC, Kim JM, Kaur G, Safaee M, Sun MZ, Singh A. Prognosis by tumor location in adults with spinal ependymomas. J Neurosurg. 2013. 18: 226-35
4. Weiner HL, Freed D, Woo HH, Rezai AR, Kim R, Epstein FJ. Intra-axial tumors of the cervicomedullary junction: Surgical results and long-term outcome. Pediatr Neurosurg. 1997. 27: 12-8
