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Spinal subependymomas are extremely rare. Fewer than 30 cases have been reported to date. All reported patients have been symptomatic. The symptoms and signs and radiologic features are indistinguishable from those of other primary intrinsic neoplasms of the spinal cord. Most occur in the cervical cord or at the cervicothoracic junction. Unlike ependymomas, which arise occasionally from the filum terminale, subependymomas have not been reported in that location. In one rare instance, the entire spinal cord was involved with tumor. In another, the cervical tumor was an extension of an intracranial medullary neoplasm.

The technique of removal of the neoplasm is no different from that used for other primary neoplasms of the spinal cord. After a median myelotomy and application of fine pial stay sutures, a plane of cleavage between the neoplasm and the cord is defined and the tumor is excised under magnification using customary surgical adjuncts such as the ultrasonic aspirator or laser, The histologic appearances of spinal subependymomas are indistinguishable from those of intracranial lesions. However, it may be difficult to arrive at the correct diagnosis based upon frozen section examination. If only a partial resection is accomplished during an initial operation because of an incorrect frozen section report, one should not hesitate to consider a second attempt at complete resection and cure.


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