Introduction: Thoracolumbar intramedullary spinal subependymomas are extremely rare spinal cord tumors with only 7 cases being reported in the pertinent literature to date.1 We report our institution’s experience with 3 consecutive cases, comprising the largest single series of this entity to date.

Methods: We performed a retrospective review of 3 patients presenting between 1995 and 2008.

Results: All three patients in our series were females and were 22, 53, and 68 years old at the time of presentation. The average duration of symptoms was 28 months. All three patients presented with both motor and sensory symptoms and one patient had evidence of bladder dysfunction. On MR imaging all three of the tumors were hypo- to isointense on T1-weighted imaging and hyperintense on T2-weighted imaging. Gross total resection (GTR) was performed in one patient and resulted in complete loss of spinal cord function below the level of the surgery. One patient underwent subtotal resection (STR) and was transiently worse after the surgery but improved. The third patient underwent biopsy and duraplasty only given the large size of the lesion and had no significant functional change postoperatively. Mean duration of follow up was 8.1 years (range 2.4 to 16 years). Each patient was followed closely with serial imaging. In the patient that underwent GTR, there was evidence of tumor recurrence after 14.7 years. This ultimately resulted in severe thoracic radicular pain prompting resection of the recurrent tumor. Serial imaging in the other two patients showed little to no significant growth in residual tumor over time.

Conclusions: We add our experience of thoracolumbar subependymomas to the literature. While no other recurrences have been reported, our experience suggests that prolonged imaging follow up may be necessary in these patients, even after GTR.

Patient Care: This case series will improve patient care by adding to the current sparse literature our series of thoracolumbar subependymomas.

Learning Objectives: By the conclusion of the session, participants should be able to: 1) Describe symptoms of thoracolumbar subependymomas. 2) Describe the imaging appearance of thoracolumbar subependymomas. 3) Describe follow up strategy for thoracolumbar subependymomas.

References: 1. Orakcioglu B, Schramm P, Kohlhof P, Aschoff A, Unterberg A, Halatsch M-E. Characteristics of thoracolumbar intramedullary subependymomas. Journal of neurosurgery Spine 2009;10:54-9.