Surgical management of a huge intramedullary ependymoma from oblongata to T4: A case report

INTRODUCTION AND IMPORTANCE: Huge intramedullary tumor is a rare condition. Surgical management of such huge ependymoma is technically challenging. We reported one case of 300 mm long intramedullary spinal cord ependymoma from oblongata to T4, which was satisfactorily en bloc gross total resected and the cervical spine alignment was successfully maintained by laminoplasty. CASE PRESENTATION: A 30-year-old man presented to our service with two-year progressive neck pain combined with bilateral sense disorders of both the upper and lower extremities. The neurological grade was ASIA D. Repeat MRI imaging demonstrated a “medulla oblongata to T4” intramedullary spinal cord tumor complicated with cervical physiological curvature loss. CLINICAL DISCUSSION: Laminectomies were made at the C1-T4 level by a milling cutter. The tumor was gently separated bilaterally. The ventral part of the tumor was separated from the cranial and the caudal ends until reaching the middle site of the tumor. The whole tumor was isolated en bloc. Titanium miniplates were used bilaterally to fix both sides of the laminoplasty section on each level. At the 2-year postoperative follow-up, the muscle strength of both the upper and lower limbs were grade Ⅳ. No tumor recurrence was detected. CONCLUSION: The total removal of an intramedullary ependymoma should be recommended as soon as the diagnosis is made, regardless of its extension. Long-level laminoplasty could be an effective alternative option to maintain the proper spine alignment.