ABSTRACT
We present a rare case of an intradural ventral arteriovenous fistula (AVF) mimicking an intramedullary ependymoma. A 46-year-old woman presented with sudden onset of right leg weakness, which she had been experiencing for two weeks. Whole-spine magnetic resonance imaging (MRI) scan revealed a 0.5-cm-sized intramedullary lesion of high signal with a dark signal rim on a T2-weighted image at the T9 level. The T1-weighted MRI after contrast enhancement revealed a nodular and rim-like enhancement. However, a signal void, likely to be seen in the case of an engorged vein, was not obvious, thus giving the impression of an intramedullary ependymoma. Surgery was planned, but was aborted due to the observation of a large engorged vein as soon as the dura was opened.
Subject(s)
Female , Humans , Middle Aged , Arteriovenous Fistula , Ependymoma , Leg , Magnetic Resonance Imaging , VeinsABSTRACT
OBJECTIVE: To evaluate the clinical results of gross total resection in the surgical approach to spinal ependymoma. METHODS: Between June 1995 and May 2009, 13 males and 8 females (mean age 34) diagnosed with intramedullary or extramedullary spinal ependymoma were surgically treated at our centre. The neurological and functional state of each patient were evaluated according to the modified McCormick scale. RESULTS: The average follow-up duration was 54 months (ranging from 12 to 168 months). The locations of the lesions were: thoracic region (4, 19%), lumbar region (7, 34%), cervical region (4, 19%), cervicothoracic region (3, 14%) and conus medullaris (3, 14%). Four patients (19%) had deterioration of neurological function in the early postoperative period. The neurological function of three patients was completely recovered at the 6th postoperative month, while that of another patient was recovered at the 14th month. In the last assessment of neurological function, 20 patients (95%) were assessed as McCormick grade 1. No perioperative complications developed in any of our patients. In one patient's 24-month assessment, tumour recurrence was observed. Re-operation was not performed and the patient was taken under observation. CONCLUSION: Two determinants of good clinical results after spinal ependymoma surgery are a gross total resection of the tumour and a good neurological condition before the operation. Although neurological deficits in the early postoperative period can develop as a result of gross total tumour resection, significant improvement is observed six months after the operation.