High cervical spinal cord ependymoma [Neurosurgery Wiki]

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====== High cervical spinal cord ependymoma ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1jsI3JGQCWWBHeEC2hWiOziiohERqeSU55ADhRPxI4_DGZKEEq/?limit=15&utm_campaign=pubmed-2&fc=20230316042323}}
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see also [[Spinal ependymoma]]
===== Videos =====

A operative [[video]] of Dekker et al. from the Department of Neurological Surgery, Neurological Institute, Case Western Reserve University, University Hospitals [[Cleveland]] Medical Center, [[Ohio]], illustrates [[resection]] of a [[High cervical]] [[spinal cord ependymoma]] in a 40-yr-old female with numbness of upper and lower extremities and ataxia. Magnetic resonance imaging (MRI) demonstrated an enhancing [[intramedullary]] [[intradural]] [[spinal]] mass at C2-3. The patient underwent a posterior cervical laminoplasty for tumor resection. 

This video highlights the [[natural history]] of this [[disease]], [[treatment]] options, surgical procedure, potential risks and [[complication]]s, and postoperative management of ependymomas. A posterior midline [[skin incision]] was made from the inion to the level of [[C4]] which exposed the posterolateral elements of C1-3. C2 and C3 lamina were removed as a single piece using the high-speed drill. A C1 laminectomy was then also performed to provide adequate superior exposure. The dura was opened widely in the midline. Careful midline [[myelotomy]] was then performed overlying the tumor. The tumor is noted to be densely adherent to the surrounding spinal cord. [[Gross total resection]] was completed using ultrasonic aspiration and [[microdissection]]. The dura was closed in a watertight fashion followed by a synthetic [[dural sealant]]. The bony elements of C2, C3 were then reconstructed using [[osteoplastic]] [[laminoplasty]], [[titanium]] [[miniplate]]s, and [[screw]]s at C2-3. The wound was closed in multiple layers using [[suture]]s. Specimens were sent for frozen and permanent pathological analysis, eventually demonstrating WHO grade II [[ependymoma]]. There were no complications. Postoperative MRI demonstrated gross total resection. The patient had an uneventful postoperative course. The strength was at baseline at long term follow-up, with small sensory deficit
((Dekker SE, Glenn CA, Ostergard TA, Rothstein BD, Bambakidis NC. High Cervical 
Ependymoma Resection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown).
2018 Aug 13. doi: 10.1093/ons/opy184. [Epub ahead of print] PubMed PMID:
30107551.
)).