The patient a Syrian citizen came to the clinic 08-February-2004 telling that he was operated 18-January-2001 elsewhere for spinal cord tumor, biopsy done and ependymoma diagnosed. Radiotherapy was applied after the first surgery, but his condition continued to deteriorate and another surgery was done elsewhere 20-November-2001. The condition continued to deteriorate.

On examination: The patient is in wheelchair with dense tetraparesis and tetra-anesthesia from the jaws and below. Foley's catheter and difficult breathing for the last 2 months. MRI done 16-September-2002 showing huge intraspinal tumor extending from D1 up to the medulla. There is scar at C3-5 levels due to previous surgeries.

The patient was sent for new investigations and MRI done 09-February-2004 showed to tumor extending from the  lower third of the medulla down to D1.

Laminectomy C1 down to D1 with exposure of the posterior fossa, posterior rim of foramen magnum. The dura was opened in the midline as needed to expose the tumor. Through separate 2 incisions practical total resection of the ependymoma was achieved until the operculum of the 4th ventricle was seen. All effort was paid to preserve and not to touch the spinal cord and its feeders.  Strict hemostasis. Routine closure of the wound. Smooth postoperative recovery. The patient was sent to the ICU to keep in ventilator for 3-4 days, because his breathing pattern before surgery was compromised.

The patient after 3 days was weaned off ventilator and the wound was clean  and sent for Syria. He was advised to perform MRI after one month, but he disappeared.

Practical total resection is the only solution to reverse the catastrophic prediction of such tumor.