Microsurgical Resection of Brain Stem Ependymoma: 2-Dimensional Operative Video

Abstract

The brainstem is a less-common location for ependymomas than the spinal cord where they are the most common adult intramedullary tumor.1-18 In this first video case report in the peer-reviewed literature, we demonstrate microsurgical resection of a medulla oblongata ependymoma. There are several case reports of medulla oblongata ependymomas1,3,5,6,13 and a few series of spinal cord ependymomas that included cases of ependymomas of the cervicomedullary junction.9,10 The goal of surgery was to stabilize the preoperative neurological function; favorable outcome is achieved in patients with good preoperative statuses and well-defined tumor boundaries.9 Although gross total resection (GTR) provides the best overall outcome, it is most effective for classic grade II tumors, but not grade I (myxopapillary) and ependymomas, which have a lower GTR rate.14,15 A 55-yr-old patient developed 4-extremity weakness and dysphagia. Pre-/postcontrast magnetic resonance imaging (MRI) revealed centrally located brainstem lesion situated at the lower half of the medulla oblongata. Surgery, performed by the senior author, was performed in the prone position with a small suboccipital craniectomy and C1 posterior arch removal, followed by pia opening and posterior midline myelotomy. Tumor was debulked, dissected from the white matter, and resected. Histology revealed ependymoma (World Health Organization grade II). Postoperative pre-/postcontrast MRI revealed total resection. The patient's neurological deficit completely resolved postoperatively. Written consent was obtained from the patient.

Ependymoma Presenting as a ­Rim-Enhancing Lesion in the Brainstem

“…There are multiple reports of patients with intramedullary cervicomedullary ependymomas in children and adults [6-9]. However, for ependymomas isolated to the brainstem, there have only been a total of 7 cases previously reported [10-16]. Of these 7 cases, only 3 were reported in pediatric patients and 2 of the 3 had tumors arising in the medulla.…”

“…He did not receive any further therapy and was followed with surveillance imaging with no evidence of tumor recurrence 3 years from surgery. The other 4 cases reported in the literature are in adults [12-14, 16].…”