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Primary extramedullary extradural ependymoma of the thoracic spine mimicking a schwannoma
  1. P De Bonis1,
  2. N Montano1,
  3. B Cioni1,
  4. C Colosimo2,
  5. L Lauriola3,
  6. F Papacci1,
  7. M Meglio1
  1. 1
    Institute of Neurosurgery, Catholic University, Rome, Italy
  2. 2
    Institute of Radiology, Catholic University, Rome, Italy
  3. 3
    Institute of Pathology, Catholic University, Rome, Italy
  1. Dr N Montano, Institute of Neurosurgery, Catholic University Largo Agostino Gemelli,8, 00168 Rome, Italy; nicolamontanomd{at}yahoo.it

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A 60-year-old woman presented with a 5-month history of paraesthesias on both feet, progressively extending upwards, bilateral leg weakness and hypoestesia. Neurological status progressively worsened, leading to paraparesis. In the last 2 weeks, she started complaining of urinary frequency and constipation. On neurological examination, the patient had diffuse lower-extremities weakness (left leg 1–2/5, right leg 3–4/5), was not able to maintain a straight posture, had a T9 sensory level and had symmetrical hyper-reflexia at the knees and ankles with left clonus; both great-toes were upgoing.

An MRI exam of the thoracic spine showed an extradural mass lesion at T9–T10, resulting in significant ventrolateral spinal cord displacement and compression; the tumour had an overall dumb-bell shape extending in the left paravertebral space through an enlarged vertebral foramen (fig 1C,D). The lesion appeared isointense on both T2- and T1-weighted images (fig 1A,B) with moderate and inhomogeneous enhancement after contrast injection (fig1C,D).

Figure 1

MRI exam (A–D), intraoperative view (E, F) and histological examination (G–I).

A presumptive preoperative diagnosis of extradural schwannoma or neurofibroma was done.

The patient underwent laminectomy from …

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