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Spinal Intramedullary Tumor

Intramedullary are uncommon tumors of spinal cord. They present with progressive weakness of limbs and bladder and bowel dysfunction. Astrocytoma and ependymoma are the two common intramedullary tumors. Surgical removal of these tumors is associated with high morbidity due to proximity to the adjacent neural elements of the spinal cord.
A 35 year old patient presented with an expanding intramedullary lesion. MRI findings (Figure 1) were suggestive of Ependymoma. The patient underwent Laminotomy and gross total excision of the tumor under continuous “intraoperative neurophysiological monitoring—Motor evoked potential (MEP)”.
Patient recovered uneventfully and improved gradually. His follow up scan showed no residual enhancing lesion with atrophy of the spinal cord.
Aids used: Microscope, Neurosurgical drill, Intraoperative monitoring (IOM), CUSA.

Figure 1a: Pre-op contrast MRI with intramedullary tumor

Figure 1b: Pre-op MRI with intramedullary tumor with solid and cystic component

Figure 1c: Follow up MRI with no residual tumor and focal cord atrophy