Resection of filum terminale ependymoma

Abstract

Keywords Spinal intradural extra medullary tumor Ependymoma Filum terminaleLearning targets• Differential diagnosis of intradural extramedullarytumors,• surgical technique of tumor resection,• surgical identification of filum terminale,• intradural tumor resection via hemilaminectomy.IntroductionSpinal intradural tumors are rare lesions. The film illus-trates the surgical technique of a resection of an intraduralextramedullary tumor just below the conus medullaris.Case descriptionA 25 year-old Caucasic man suffered from pain of thethoracolumbar junction since 5 years. After experiencing arecent exacerbation of pain since some weeks a MR scan ofthe lumbar and thoracic spine was obtained. Imagingrevealed an intradural spinal tumor behind T12 and L1 justbelow the level of the conus. The tumor was contrastenhancing and filled almost the complete diameter of thespinal canal.Physical examination revealed no neurological deficits.Surgical procedureThe patient was placed in prone position and the spinallevels T12 and L1 were identified. After a left-sided uni-lateral exposure of the bony spine, a complete left-sidedhemilaminectomy of T12 and a partial hemilaminectomyof T11 and L1 were performed with a high-speed drill andpunches. A longitudinal durotomy was performed and thetumor exposed. As a first step in the tumor resection thetumor was stepwise debulked with an ultrasonic aspirator.After debulking the cranial attachment of the tumor wasvisible and the tumor origin from the filum terminale(identified by the typical artery on the filum) was revealed.Finally, the tumor was resected by cutting the filum.Postoperative informationThe patient recovered well. He complained of some sur-gery associated wound pain, other than that he was com-pletely without any symptoms and neurologically fullyintact. No complications were observed. Postoperative MRimaging documented a complete resection of the tumor,Watch surgery online