CASE REPORT
Os tumores intramedulares da medula espinhal são neoplasias raras, sendo o ependimoma o mais comum em adultos. O tratamento de escolha é cirúrgico por fornecer um diagnóstico histológico e prevenir disfunções neurológicas a longo prazo. O objetivo deste trabalho foi relatar o caso de um tumor intramedular extenso em um paciente jovem de 17 anos com história evolutiva de 3 anos de cervicalgia, déficit motor grave e disfunção esfincteriana, com RM evidenciando lesão intramedular acometendo C2 a T4, com ressecção completa. No exame anatomopatológico o resultado foi compatível com ependimoma grau 2. O paciente evoluiu com melhora significativa dos sintomas e déficits motores, mesmo após meningite, e atualmente está deambulando.
Intramedullary spinal cord tumors are rare neoplasms, with ependymoma being the most common in adults. The treatment of choice
for ependymomas is surgical, as it provides a histological diagnosis and prevents long-term neurological disorders. We report the case
of a 17-year-old patient with a 3-year history of neck pain and severe motor deficit and sphincter dysfunction, with MRI showing an
intramedullary lesion affecting C2 to T4, with complete resection. In the pathological examination, there was evidence of a grade 2
ependymoma. The patient evolved with significant improvement in symptoms and motor deficits and is currently walking.
1. Greenberg M. Handbook of neurosurgery. 8th ed. New York: Thieme; 2016. http://dx.doi.org/10.1055/b-006-149702.
2. Kahan H, Sklar EM, Post MJ, Bruce JH. MR characteristics of histopathologic subtypes of spinal ependymoma. AJNR Am J Neuroradiol. 1996;17(1):143-50. PMid:8770266.
3. Ross D, Rosegay H, Pons V. Differentiation of aseptic and bacterial meningitis in postoperative neurosurgical patients. J Neurosurg. 1988;69(5):669-74. http://dx.doi.org/10.3171/jns.1988.69.5.0669. PMid:3183729.
4. Leeper H, Felicella MM, Walbert T. Recent advances in the classification and treatment of ependymomas. Curr Treat Options Oncol. 2017;18(9):55. http://dx.doi.org/10.1007/s11864-017-0496-7. PMid:28795287.
5. Friede RL, Pollak A. The cytogenetic basis for classifying ependymomas. J Neuropathol Exp Neurol. 1978;37(2):103-18. http:// dx.doi.org/10.1097/00005072-197803000-00001. PMid:632843.
6. Kawano N, Yada K, Yagishita S. Clear cell ependymoma: a histological variant with diagnostic implications. Virchows Arch A Pathol Anat Histopathol. 1989;415(5):467-72. http://dx.doi.org/10.1007/BF00747748. PMid:2477945.
7. Ellison DW, Aldape KD, Capper D, et al. cIMPACT-NOW update 7: advancing the molecular classification of ependymal tumors. Brain Pathol. 2020;30(5):863-6. http://dx.doi.org/10.1111/bpa.12866. PMid:32502305.
8. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro Oncol. 2021;23(8):1231-51. http://dx.doi.org/10.1093/neuonc/noab106. PMid:34185076.
9. Kothbauer KF. Neurosurgical management of intramedullary spinal cord tumors in children. Pediatr Neurosurg. 2007;43(3):222-35. http:// dx.doi.org/10.1159/000098835. PMid:17409792.
10. Wiestler OD, Schiffer D, Coons SW, et al. Ependymoma. In: Kleihues P, Cavenee K, editors. World Health Organization classification of tumours: tumours of the nervous system. Lyon: IARC Press; 2000. p. 72-7.
11. Barbagallo GMV, Caltabiano R, Parisi G, Albanese V, Lanzafame S. Giant cell ependymoma of the cervical spinal cord: case report and review of the literature. Eur Spine J. 2009;18(Suppl 2):186-90. http:// dx.doi.org/10.1007/s00586-008-0789-4.
12. Chamberlain MC. Ependymomas. Curr Neurol Neurosci Rep. 2003;3(3):193-9. http://dx.doi.org/10.1007/s11910-003-0078-x. PMid:12691623.
13. Engelhard HH, Villano JL, Porter KR, et al. Clinical presentation, histology, and treatment in 430 patients with primary tumors of the spinal cord, spinal meninges, or cauda equina. J Neurosurg Spine. 2010;13(1):67-77. http://dx.doi.org/10.3171/2010.3.SPINE09430. PMid:20594020.
14. Klekamp J. Spinal ependymomas. Part 1: intramedullary ependymomas. Neurosurg Focus. 2015;39(2):E6. http://dx.doi. org/10.3171/2015.5.FOCUS15161. PMid:26235023.
15. Raghunathan A, Wani K, Armstrong TS, et al. Histological predictors of outcome in ependymoma are dependent on anatomic site within the central nervous system. Brain Pathol. 2013;23(5):584-94. http://dx.doi. org/10.1111/bpa.12050. PMid:23452038.
16. Kosztowski T, Fridley JS, Gokaslan ZL. Spinal cord ependymomas. In: Arnautović KI, Gokaslan ZL, editors. Spinal cord tumors. Cham: Springer; 2019. p. 325-36. http://dx.doi.org/10.1007/978-3-319-99438-3_17.
17. Oh MC, Ivan ME, Sun MZ, et al. Adjuvant radiotherapy delays recurrence following subtotal resection of spinal cord ependymomas. Neuro Oncol. 2013;15(2):208-15. http://dx.doi.org/10.1093/neuonc/ nos286. PMid:23229996.
18. Schwartz TH, McCormick PC. Intramedullary ependymomas: clinical presentation, surgical treatment strategies and prognosis. J Neurooncol. 2000;47(3):211-8. http://dx.doi.org/10.1023/A:1006414405305. PMid:11016737.
19. Celano E, Salehani A, Malcolm JG, Reinertsen E, Hadjipanayis CG. Spinal cord ependymoma: a review of the literature and case series of ten patients. J Neurooncol. 2016;128(3):377-86. http://dx.doi.org/10.1007/ s11060-016-2135-8. PMid:27154165.
20. Wagle WA, Jaufman B, Mincy JE. Intradural extramedullary ependymoma: MR-pathologic correlation. J Comput Assist Tomogr. 1988;12(4):705-7. http://dx.doi.org/10.1097/00004728-198807000- 00045. PMid:3392287.
21. Mineura K, Shioya H, Kowada M, Ogawa T, Hatazawa J, Uemura K. Subependymoma of the septum pellucidum: characterization by PET. J Neurooncol. 1997;32(2):143-7. http://dx.doi.org/10.1023/A:1005784020134. PMid:9120543.
22. Paulino AC, Wen BC, Buatti JM, et al. Intracranial ependymomas: an analysis of prognostic factors and patterns of failure. Am J Clin Oncol. 2002;25(2):117-22. http://dx.doi.org/10.1097/00000421-200204000- 00003. PMid:11943886.
23. Quigley DG, Farooqi N, Pigott TJ, et al. Outcome predictors in the management of spinal cord ependymoma. Eur Spine J. 2007;16(3):399- 404. http://dx.doi.org/10.1007/s00586-006-0168-y. PMid:16865377.
24. Sandalcioglu IE, Gasser T, Asgari S, et al. Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients. Spinal Cord. 2005;43(1):34-41. http://dx.doi.org/10.1038/ sj.sc.3101668. PMid:15326473.
25. Fotso CB, Abaver DT, Muballe D, Vasaikar S, Apalata T. Postoperative infections: aetiology, incidence and risk factors among neurosurgical patients in Mthatha, South Africa. S Afr Med J. 2020;110(5):403-8. http://dx.doi.org/10.7196/SAMJ.2020.v110i5.13779. PMid:32657726.
26. Taha MM, Abouhashem S, Abdel-Rahman AY. Neurosurgery wound infection at a university hospital in Egypt: prospective study of 1181 patients for 2 years. Turk Neurosurg. 2014;24(1):8-12. PMid:24535784.
27. Kim B-N, Peleg AY, Lodise TP, et al. Management of meningitis due to antibiotic-resistant Acinetobacter species. Lancet Infect Dis. 2009;9(4):245-55. http://dx.doi.org/10.1016/S1473-3099(09)70055-6. PMid:19324297.
28. Pajtler KW, Witt H, Sill M, et al. Molecular classification of ependymal tumors across all CNS compartments, histopathological grades, and age groups. Cancer Cell. 2015;27(5):728-43. http://dx.doi.org/10.1016/j. ccell.2015.04.002. PMid:25965575.
29. Reichert MCF, Medeiros EAS, Ferraz FAP. Hospital-acquired meningitis in patients undergoing craniotomy: incidence, evolution, and risk factors. Am J Infect Control. 2002;30(3):158-64. http://dx.doi. org/10.1067/mic.2002.119925. PMid:11988710.
1 MD, Neurosurgeon, Neurosurgery Service, Hospital das Clínicas de Marília – HC FAMEMA, Marília, SP, Brazil.
2 Medicine Student, Internship Student of Medicine, University of Marília – UNIMAR, Marília, SP, Brazil.
3 MD, PhD, Neurosurgeon Chief, Neurosurgery Service, Hospital das Clínicas de Marília – HC FAMEMA, Marília, SP, Brazil.
Received Oct 31, 2022
Corrected Feb 6, 2023
Accepted Feb 6, 2023
