Spinal ependymomas are the most common intramedullary tumors in adults, yet they rarely extend across numerous vertebral segments. This case study highlights the complexities involved in Giant spinal ependymoma surgery, focusing on a 16-cm lesion spanning 11 spinal levels. Such cases represent significant diagnostic and therapeutic challenges due to the critical neural structures involved.

A 31-year-old female patient presented with a history of progressive neck pain, lower extremity weakness, and sensory deficits. Diagnostic imaging via MRI identified a massive intramedullary lesion extending from the C1 to T4 levels. Consequently, the surgical team decided on an aggressive intervention to prevent further neurological decline. Furthermore, the implementation of multimodal intraoperative neuromonitoring was prioritized to safeguard spinal cord integrity during the resection.

Technical Excellence in Giant Spinal Ependymoma Surgery

The surgical approach involved a multi-level laminectomy from C1 to T4, followed by a posterior longitudinal midline myelotomy. This technique allowed the surgeons to achieve a gross-total en bloc resection of the 16-cm tumor. Moreover, pathological examination confirmed the mass as a WHO grade 2 ependymoma. Postoperative imaging verified that no residual tumor remained, which is the primary prognostic indicator for long-term survival in these patients.

Recovery from such extensive spinal surgery is often marked by transient neurological deficits. In this instance, the patient experienced temporary motor weakness but showed steady improvement during follow-up assessments. Transitioning into early physical therapy is vital for optimizing motor recovery. Therefore, while the procedure is technically demanding, successful outcomes are attainable through meticulous microsurgical techniques and timely intervention.

Clinical Lessons for Managing Giant Intramedullary Tumors

Early recognition of symptoms is essential for improving the functional outlook of patients with spinal cord tumors. Although multilevel tumors carry a higher risk of postoperative deficits, this case demonstrates that total resection is feasible. Additionally, the integration of real-time neuromonitoring provides a critical safety margin during myelotomy. Ultimately, multidisciplinary care and advanced surgical planning remain the cornerstones of managing these rare and massive spinal pathologies.

Frequently Asked Questions

What are the common symptoms of a giant spinal ependymoma?

Patients often experience progressive neck or back pain, motor weakness in the limbs, and sensory disturbances such as numbness or tingling due to spinal cord compression.

Is total resection always possible for large spinal tumors?

While challenging, gross-total resection is the goal for WHO grade 2 ependymomas. Success depends on the tumor's plane of cleavage from the spinal cord and the use of microsurgical techniques.

What is the typical postoperative recovery for these patients?

Many patients face transient neurological worsening immediately after surgery. However, with intensive rehabilitation and physical therapy, many achieve significant functional recovery over several months.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider regarding any medical condition. Refer to the latest local and national guidelines for clinical practice.

References

1. Rivera-Rivera ER et al. Giant intradural intramedullary spinal ependymoma: illustrative case. J Neurosurg Case Lessons. 2026 Mar 30. doi: undefined. PMID: 41911605.


2. Rudà R et al. EANO guidelines for the diagnosis and treatment of ependymal tumors. Neuro-Oncology. 2018;20(4):445-456.


3. Sun B et al. Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients. J Neurosurg Spine. 2014;21(3):371-378.