Fig. 3.

Cervical ependymoma. A 53-year-old male who presented with several months of bilateral hand numbness and problems with gait. (A) Radiographic findings. (I) MRI revealed cervical intradural intramedullary lesion. Sagittal T1-weighted MRI revealed some enlargement of cervical spinal cord. (II) Sagittal T1-weighted MRI with contrast revealed diffuse contrast enhancement from C3 to C6 with evidence of cystic changes at rostral portion of lesion (arrow). (III) Axial T1-weighted MRI at level of cyst. (IV) Axial T1-weighted MRI with contrast at level of cyst. Patient underwent C2 to C6 laminoplasty and resection of tumor. (V) Postoperative sagittal T1-weighted MRI with contrast revealed good resection. (VI) Axial T1-weighted MRI with contrast revealed removal of cyst. (VII) Two years later, patient’s symptoms have improved and sagittal T1-weighted MRI reveals continued absence of tumor. (VIII) Axial T2-weighted MRI reveals absence of tumor and resolution of cystic changes. (B) Intraoperative photographs. (I) Midline myelotomy was done with CO2 laser (arrow). (II) Tumor is debulked using ultrasonic aspirator (arrow). (III) A good surgical plane at rostral end of tumor was found, allowing for removal of tumor without invasion into spinal cord parenchyma. (IV) Inspection of resection cavity revealed GTR of tumor. (C) Classically demonstrate perivascular pseudorosettes (ie, tumor cells radially arranged around a central vessel, with their pink fibrillary processes extending like spokes inward to the vessel, A) and true ependymal rosettes (ie, tumor cells radially arranged a nonvascular lumen, B). Scale bar = 50 μm. Magnification = 200×.