The patient  came to the clinic 10-April-2012 complaining of LBP for one year with bilateral sciatica for 4 months more tot eh left not reaching below the knees. The patient has difficult micturition for 4 months and difficult walking for 10 days. The patient had 2 episodes of convulsions the first 3 years ago and the second 18 months ago, for what he is receiving Depakine 500 twice daily.

MRI lumbar spine performed 05-April-2012 showing intradural tumor behind D12-L2 with involvement of the spinal cord and the cauda equina.

On examination, the patient has shuffling gait. Romberg position was stable. He has intention tremor both hands. SLRS was 70 degrees due to weakness both sides. The knee jerk was present in the left side with possible Babinski in the right side, but without clonus. There is profound weak dorsi and planterflexion both feet -3/5. Adduction of the knees 4/5, abduction 3/5. The right quadriceps muscle power was 4/5 and the left -4/5. There is hypalgesia around the anal region.

The patient was sent for MRI of the brain , cervical and dorsal spine, which were done 10-April-2012, confirming the presence of moderate ventricular dilatation above the tentorium, holding the suspicion of NPH. The above mentioned tumor is the same as before.

Laminectomy of D12, L1 and L2 under the image-intensifier. There is sacralaization of L5. The dura was opened from the upper border of the tumor down to its lower border. The exophytic parts of the tumor which looks as ependymoma was removed. Using ISIS Inomed HighLine neuronavigation, the intermingled roots in side the tumor were preserved. The spinal cord was infiltrated by the tumor diffusely. It was studied and decision to leave it was appreciated. Some segments of the cauda equina was totally freed from the tumor. Other segments were adherent with the tumor dirt which was maximally removed without injuring the running roots. After resection of the tumor check of spinal cord function was checked and it was functioning in both sides with all running roots.

Routine closure of the wound. Smooth postoperative recovery. The power of the lower limbs improved more in the left side..

The patient has a tumor that at places it was diffusely invading the spinal cord and at other places it has an exophytic growth. All the exophytic growth was removed.

The final histologic result was ependymoma. For more information about this pathology please refer to: ependymomas.com.