Surgical management of intramedullary spinal ependymomas.

Background: Spinal intramedullary ependymoma is a rare disease with a wide range of clinical presentation, generally requiring surgical treatment.

Objective: Report our experience and present our surgical technique to achieve total resection and cure.

Method: We present 12 consecutive cases of intramedullary ependymomas operated between 2000 and 2008 by the senior author (HT). The functional scale proposed by McCormick was used to evaluate the patients' neurological status.

Results: Age at presentation varied from 18 to 55 (average 36) years. All tumors had a benign histology. Four (33%) patients were male and eight (67%) were female. According to the site of presentation, six (50%) were localized at the cervical region (including two at the cervicomedullary junction, two at the cervico-thoracic junction and two exclusively at the cervical level), four at the thoracic level and two at the conus/ cauda equina. Dyshestesia was a common finding at the neurological exam in eight patients (67%). Total resection was achieved in all cases. Six patients showed neurological improvement postoperatively, whereas the other six remained stable.

Conclusion: Adequate knowledge of anatomy and the correct use of microsurgical techniques allowed total resection of these tumors with minimal morbidity and maximum functional recovery.