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SPINAL CORD TUMOR CASE STUDIES

A. FILUM TERMINALE EPENDYMOMA

Case1. J.L. is a 19 year old male with a three (3) month history of lower back and right hip, groin and flank pain. The patient's neurological examination was negative for any deficits. MRI demonstrated an ovoid "enhancing" intradural mass lesion.

Figure 1: MRI Scan Series (Gadolinium Enhanced-Sagittal View) of an L1-L2 Level Intradural Spinal Cord Tumor in a 19 Year Old Male

This MRI Scan series demonstrates the extent and some of the anatomical characteristics of the Intradural Filum Terminale Ependymoma (Curved Arrows).

The Center image suggests that the tumor extends into the distal end of the Filum (Straight Arrow). This proved to be the case at surgery.

Figures 2A (Left) & 2B (Right): MRI Scan (Gadolinium Enhanced-Axial View-Same Patient) The Tumor fills the entire Spinal Canal (Down-curved Arrows). The remaining Spinal Nerve Roots are compressed and crowded against the Laminar Bone, indicated by the small black "dots" at the back of the Spinal Canal (Up-curved and Straight Arrows).

Figure 3: Operative Photo (Same Patient). The "End" of the Spinal Cord (Filum Terminale) is seen (Down Arrow) just above the Tumor. A "Lipoma" (Fatty) Cystic portion (Up-Arrow) lies between the Tumor (Curved Arrows) and the Filum Terminale.

Figure 3: Post-myelographic CT Scan (Axial View)

Figure 3 (Left): Operative Photo (Same Patient)
Magnified View of the surgical dissection of the Filum Terminale (Down Arrow) and the Lipoma Cystic (Up-Arrow) portion of the Tumor (Curved Arrow)

Figure 4 (Below): Operative Photo (Same Patient)
The Filum Terminale Ependymoma has been entirely removed. The "cut end" (Up-curved Arrow) of the Filum was proven to be free of tumor by pathology samples taken at the time of the operation. The intradural Nerve Roots that continue to their ultimate destination (3-pronged Arrow) are now free of the previous compression and remain completely intact. The patient suffered no ill effects and has resumed a full and active life.

Figure 4: A complete resection of a Filum Terminale Ependymoma was accomplished. This patient is free of any neurological deficits. See the explanation in the "text box" above.



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This page last edited on 2/19

All content ©2016 by Neurosurgical Consultants, P.A.
Author, Martin L. Lazar, MD, FACS
All Rights Reserved. See Usage Notices.