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Vol. 18. Issue 4.
Pages 333-336 (January 2007)
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Vol. 18. Issue 4.
Pages 333-336 (January 2007)
Late dissemination of ependymoma: case report
Diseminación tardía de un ependimoma. Caso clínico
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G. Bademci
, C. Evliyaoglu
Department of Neurosurgery, University of Kirikkale, Faculty of Medicine, Kirikkale, Turkey
K. Tun*, E. Erden**, A. Unlu***
* Neurosurgery Division, Ankara Numune Hospital, Ankara, Turkey
** Department of Pathology, Ankara University, School of Medicine, Ankara, Turkey
*** Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
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Summary

Spinal cord dissemination over 10 years after surgical removal of the fourth ventricle ependymoma without local recurrence is extremely rare. A 49-year-old male underwent a macroscopically gross total removal of the fourth ventricle ependymoma and postoperative radiothe rapy to the posterior fossa. Twelve years after the initial operation, the patient complained from uncontrolled fever attacks, low back pain and numbness of the legs. Spinal Magnetic Resonance Imaging revealed intradural extramedullary mass lesions located at the thoracic 2-3 and lumbar 5 vertebrae levels. Cerebrospinal fluid exami nation showed no tumour cells. He underwent total excision of these spinal lesions. Although the majority of the recurrences take place within a few years after surgery, we experienced a case with multiple spinal disseminations 12 years after the resection of the fourth ventricle ependymoma and administration of the radiation therapy to the posterior fossa. Up to our knowledge, this case represents the second unusual late recurrence reported in the literature. We conclude that low grade ependymomas should be followed neurologically and radiologically for more than 10 years after the initial treatment.

Key words:
Ependymoma
Dissemination
Spinal cord
Abreviaturas:
CSF
CT
MRI
RT
Resumen

La diseminación raquídea, después de la extirpación quirúrgica de un ependimoma del cuarto ventrículo, sin recurrencia local, es muy rara. Un varón de 49 años fue intervenido de un ependimoma del IV ventrículo, con resección total y radioterapia postoperatoria de la fosa posterior. Doce años después de esta intervención, el paciente comenzó a quejarse de episodios febriles incontrolables, dolor lumbar y adormecimiento en las piernas. La resonancia magnética mostraba lesiones localizadas a la altura de la 2-3ª vértebra dorsal y de la L5. El líquido cefalorraquídeo no mostraba células tumorales. Fue operado de ambos tumores raquídeos, con resección total.

Aunque la mayoría de las recurrencias tienen lugar en los primeros años después de la operación, hemos observado un caso con diseminación raquídea múltiple, después de la resección de un ependimoma del IV ventrículo y radioterapia de la fosa posterior. Que sepamos, este caso es el segundo de recurrencia tardía, publicado en la literatura. En conclusión, los ependimomas de bajo grado deben ser vigilados neurológica y radiológicamente durante más de diez años después del tratamiento inicial.

Palabras clave:
Ependimoma
Diseminación
Médula espinal

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