49. Neurophysiological monitoring in surgery of cervical subependimomas

Abstract

Subependymomas are lesions that typically arise in the fourth and lateral ventricles. Subependymomas of the spinal cord are rare and only 33 cases have been described. These lesions are subpial, and eccentrical in location and present an exophytic component. We report the case of a 54-years old woman who came to our attention complaining for a five months history of neck pain and burning paresthesia in her right upper limb. Neurological examination revealed severe hyperreflexia and a grade 3/5 power in her right upper and lower limb. MRI with gad revealed a hyperintense intramedullary lesion on T2-weighted images at the level of C2–C3 and C4, with minimal post-contrast enhancement. The lesion was removed through a C2 to C4 laminectomy. A cleavage plane was evident and the lesion was removed in a peacemeal manner. The entire procedure was performed under neurophysiological monitoring (PES, PEM, D-wave, EMG free-run); at the end of the removal, there was an improvement in the motor evoked potentials of the right upper limb. The patient was able to ambulate from the second postoperative day and her right upper strength slightly improved; MRI with gad revealed a gross total removal of the lesion. Histological examination revealed a subependymoma.