[Intramedullary subependymoma of the cervical spinal cord. Review of the literature a propos of a case].
A case of intramedullary subependymoma (SE) of the cervical spinal cord is reported. A 35 year-old female patient developed paresthesiae in her right upper and lower limbs for approximately two years. Magnetic resonance imaging (MRI) of the cervical spinal cord disclosed an intrisic medullary tumor at the C2-C3 levels, predominantly involving the right hemicord. At surgery, a subpial ependymoma was totally removed using the ultrasonic surgical aspirator with no resulting anomalies of the intraoperative somatosensory evoked responses. The patient made a good recovery. At one-year follow-up, she had resumed her previous occupation and complained only from minor sequelae. Twenty-nine spinal cord SE of the literature are detailed. It is likely that they account for less than two per cent of all spinal cord tumors. A majority of cases involved the cervical cord or the cervicothoracic junction. Signs and symptoms are similar to those of other spinal intramedullary tumors. In 17 cases explored by MRI, no specific pattern could distinguish SE from astrocytomas or ependymomas, except perhaps for a more marked tendency for SE to grow excentrically within the cord or to show an exophytic component. Spinal cord SE show pathological features grossly comparable to those described in intracranial SE with clusters of small glial cells scattered among densely packed fibers. Histogenesis of SE has been a matter of debate over years, whereas it is currently admitted that they may represent a variant of ependymomas. In conclusion, most clinical and imaging features of spinal cord SE are similar to those of other pathological varieties. Radical removal is the most appropriate treatment modality, despite inherent risk of postoperative deterioration and significant sequelae on long term follow-up.
Service de Neurochirurgie B, Hôpital Neurologique, Lyon.
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P
Bret
R
R
Bougeard
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G
Saint-Pierre
J
J
Guyotat
A C
AC
Ricci
C
C
Confavreux
D000328:Adult; D005260:Female; D018315:Glioma, Subependymal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000601:surgery*