Interactive Transcript
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I've referred to the ependymomas of the
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intradural extramedullary space.
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These are typically called the filum terminale
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ependymomas or myxopapillary ependymomas.
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And they are not in the spinal cord,
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but in the little fibrous tissue at the end
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of the spinal canal, the filum terminale.
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These are grade 1, low-grade tumors,
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generally considered benign,
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that can be removed surgically.
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There's a slight male predilection.
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They're very slow growing.
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These may have calcification or hemorrhage
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or cystic change within them.
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This lesion looks almost exactly like our cystic
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schwannoma that we referred to previously.
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However, this was a myxopapillary ependymoma.
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The features of it that would be suggestive of that
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are the cystic nature of the lesion, as well as
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its occurrence here at the filum terminale.
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So the filum terminale lesions generally are more
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centrally located than nerve root lesions.
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Nerve roots are going to be in the
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periphery of the thecal sac.
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The filum terminale would be in the center of the thecal sac.
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It is not uncommon for them to have mixed signal
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intensity because of the possibility of cysts or
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hemorrhage, or occasionally even calcification.
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The location in the center of the thecal sac, as opposed to
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the periphery, would also be a feature that would
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suggest a filum terminale ependymoma.
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These lesions are very slow growing.
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They may remodel bone. And in point of fact, on this sagittal scan,
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you might wonder about whether there's a little bit of
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posterior scalloping of L4 associated with
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the ependymoma. Most of these ependymomas,
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when they're discovered,
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are large lesions because they are relatively
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asymptomatic and they're slow growing tumors.
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Sometimes you will see them erode through the bone and
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infiltrate the sacrum quite widely
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and, actually, extend extradurally.
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So this is yet another of the intradural extramedullary
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tumors that can occasionally become extradural
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outside the thecal sac. And here's an example.
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This is a myxopapillary ependymoma, and frankly,
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it looks very aggressive, right?
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So let's look at this T1-weighted scan in the center here.
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Notice that there is scalloping of the bone.
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So, it's maybe some features that suggest slow growing.
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But look at the sacrum.
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This is the S1 bone and this is the S2 bone.
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So this is an example of an intradural extramedullary
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benign tumor that is infiltrating the sacrum
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in a very aggressive fashion.
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You can see the...
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actually, on the T2-weighted scan, this bright signal intensity
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of sacral bone invasion by a benign
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myxopapillary ependymoma.
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And you see also that it does show contrast enhancement.
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So an intradural extramedullary lesion that is growing
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extradurally and is yet a benign tumor.
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On the axial scan,
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you can see that there also was growth posteriorly
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through the posterior elements,
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which you're seeing here by this mass.
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Now, this mass presented at this size.
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So, it just goes to show how these lesions are relatively
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asymptomatic slow growing and present
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as a very large lesion.
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This lesion is going to be still operated on surgically
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because it can still be resected and
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have a relatively good outcome.
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