Delay to Care for Spinal Ependymoma and Overall Management: Case Report and Review of the Literature

Introduction: Spinal ependymomas are the most common intramedullary tumor in adults. Common presenting symptoms include sensory loss, back pain, and ataxia. The mean duration before diagnosis has been reported at 15.1 months. This delay in diagnosis may be related to the progressive development of nonspecific symptoms; however, earlier treatment may improve outcomes and limit muscle atrophy. This demonstrates a need for an improved process for diagnosing these neoplasms. We present the case of a 62-year-old man who arrived at the emergency department after a motor vehicle accident and was found to have an incidental intramedullary tumor in the cervical spine on MRI, and we summarize the current literature around diagnosis and treatment of spinal ependymomas.

Methods: A systematic review was completed using Pubmed/Medline, Scopus, and Web of Science regarding diagnosis and treatment of cervical ependymomas.

Results: Our case describes a patient that had over a year of progressive bilateral upper extremity and right lower extremity weakness. An incidental intramedullary tumor in the cervical spine was discovered after a motor vehicle accident, and he was treated by microscopic gross total resection (GTR) of the tumor. Following tumor resection, cervical MRI demonstrated GTR with a residual cystic cavity between C5 and T2. Post-operatively, the patient completed three weeks of inpatient rehabilitation for strength. Clinically, he endorsed improvement in sensation and strength, although still weaker on the right side. No plan for adjuvant radiotherapy was made. Through our literature review, several articles discussed the diagnosis of ependymoma and differentiation from astrocytoma based on MRI images, outcomes following surgical resection, and prediction of long-term outcomes or recurrence.

Conclusion : Spinal ependymomas are tumors that lead to progressive symptoms, which often leads to delay in treatment. Due to the potential long-term impact, improved detection and management of these tumors is needed.