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Spine
Diagnosis
Neoplasms, Cysts, and Other Masses
Neoplasms
Intramedullary
Ependymoma
Ependymoma
Jeffrey S. Ross, MD; Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Spinal ependymoma

              • Definitions

                • Neoplasm arising from ependyma lining spinal cord central canal

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nonvascular Interventions

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Alizada O et al: Surgical management of spinal intramedullary tumors: ten-year experience in a single institution. J Clin Neurosci. 73:201-8, 2020
                                              2. Gerstner ER et al: Ependymoma. Semin Neurol. 38(1):104-11, 2018
                                              3. Khalid SI et al: Pediatric spinal ependymomas: an epidemiologic study. World Neurosurg. 115:e119-28, 2018
                                              4. Kobayashi K et al: MRI characteristics of spinal ependymoma in WHO grade II: a review of 59 cases. Spine (Phila Pa 1976). 43(9):E525-30, 2018
                                              5. Merchant TE: Current clinical challenges in childhood ependymoma: a focused review. J Clin Oncol. 35(21):2364-9, 2017
                                              6. Li TY et al: Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients. J Neurosurg Spine. 21(2):249-59, 2014
                                              7. Kim BS et al: Extra and intramedullary anaplastic ependymoma in thoracic spinal cord. Korean J Spine. 10(3):177-80, 2013
                                              8. Gilbert MR et al: Ependymomas in adults. Curr Neurol Neurosci Rep. 10(3):240-7, 2010
                                              9. Rudà R et al: Ependymomas of the adult: molecular biology and treatment. Curr Opin Neurol. 21(6):754-61, 2008
                                              10. Robles SG et al: Intradural extramedullary spinal ependymoma: a benign pathology? Spine (Phila Pa 1976). 30(9):E251-4, 2005
                                              11. Chamberlain MC: Ependymomas. Curr Neurol Neurosci Rep. 3(3):193-9, 2003
                                              12. Sun B et al: MRI features of intramedullary spinal cord ependymomas. J Neuroimaging. 13(4):346-51, 2003
                                              13. Carter M et al: Genetic abnormalities detected in ependymomas by comparative genomic hybridisation. Br J Cancer. 86(6):929-39, 2002
                                              14. Chang UK et al: Surgical outcome and prognostic factors of spinal intramedullary ependymomas in adults. J Neurooncol. 57(2):133-9, 2002
                                              15. Choi JY et al: Intracranial and spinal ependymomas: review of MR images in 61 patients. Korean J Radiol. 3(4):219-28, 2002
                                              16. Hanbali F et al: Spinal cord ependymoma: radical surgical resection and outcome. Neurosurgery. 51(5):1162-72; discussion 1172-4, 2002
                                              17. Jeuken JW et al: Correlation between localization, age, and chromosomal imbalances in ependymal tumours as detected by CGH. J Pathol. 197(2):238-44, 2002
                                              18. Hirose Y et al: Chromosomal abnormalities subdivide ependymal tumors into clinically relevant groups. Am J Pathol. 158(3):1137-43, 2001
                                              19. Koeller KK et al: Neoplasms of the spinal cord and filum terminale: radiologic-pathologic correlation. Radiographics. 20(6):1721-49, 2000
                                              20. Lagares A et al: Spinal cord ependymoma presenting with acute paraplegia due to tumoral bleeding. J Neurosurg Sci. 44(2):95-7; discussion 97-8, 2000
                                              21. Miyazawa N et al: MRI at 1.5 T of intramedullary ependymoma and classification of pattern of contrast enhancement. Neuroradiology. 42(11):828-32, 2000
                                              22. Wiestler OD et al: Ependymoma. In Kleihues P, Cavanee WK. Pathology & Genetics of Tumors of the Central Nervous System. Lyon: IARC Press. 72-7, 2000
                                              23. Graf M et al: Extraneural metastasizing ependymoma of the spinal cord. Pathol Oncol Res. 5(1):56-60, 1999
                                              24. Mazewski C et al: Karyotype studies in 18 ependymomas with literature review of 107 cases. Cancer Genet Cytogenet. 113(1):1-8, 1999
                                              25. Bourgouin PM et al: A pattern approach to the differential diagnosis of intramedullary spinal cord lesions on MR imaging. AJR Am J Roentgenol. 170(6):1645-9, 1998
                                              26. Kahan H et al: MR characteristics of histopathologic subtypes of spinal ependymoma. AJNR Am J Neuroradiol. 17(1):143-50, 1996
                                              27. Fine MJ et al: Spinal cord ependymomas: MR imaging features. Radiology. 197(3):655-8, 1995
                                              28. Waldron JN et al: Spinal cord ependymomas: a retrospective analysis of 59 cases. Int J Radiat Oncol Biol Phys. 27(2):223-9, 1993
                                              29. Nemoto Y et al: Intramedullary spinal cord tumors: significance of associated hemorrhage at MR imaging. Radiology. 182(3):793-6, 1992
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Spinal ependymoma

                                                          • Definitions

                                                            • Neoplasm arising from ependyma lining spinal cord central canal

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Nonvascular Interventions

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Staging, Grading, & Classification

                                                                            • Gross Pathologic & Surgical Features

                                                                              • Microscopic Features

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Alizada O et al: Surgical management of spinal intramedullary tumors: ten-year experience in a single institution. J Clin Neurosci. 73:201-8, 2020
                                                                                          2. Gerstner ER et al: Ependymoma. Semin Neurol. 38(1):104-11, 2018
                                                                                          3. Khalid SI et al: Pediatric spinal ependymomas: an epidemiologic study. World Neurosurg. 115:e119-28, 2018
                                                                                          4. Kobayashi K et al: MRI characteristics of spinal ependymoma in WHO grade II: a review of 59 cases. Spine (Phila Pa 1976). 43(9):E525-30, 2018
                                                                                          5. Merchant TE: Current clinical challenges in childhood ependymoma: a focused review. J Clin Oncol. 35(21):2364-9, 2017
                                                                                          6. Li TY et al: Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients. J Neurosurg Spine. 21(2):249-59, 2014
                                                                                          7. Kim BS et al: Extra and intramedullary anaplastic ependymoma in thoracic spinal cord. Korean J Spine. 10(3):177-80, 2013
                                                                                          8. Gilbert MR et al: Ependymomas in adults. Curr Neurol Neurosci Rep. 10(3):240-7, 2010
                                                                                          9. Rudà R et al: Ependymomas of the adult: molecular biology and treatment. Curr Opin Neurol. 21(6):754-61, 2008
                                                                                          10. Robles SG et al: Intradural extramedullary spinal ependymoma: a benign pathology? Spine (Phila Pa 1976). 30(9):E251-4, 2005
                                                                                          11. Chamberlain MC: Ependymomas. Curr Neurol Neurosci Rep. 3(3):193-9, 2003
                                                                                          12. Sun B et al: MRI features of intramedullary spinal cord ependymomas. J Neuroimaging. 13(4):346-51, 2003
                                                                                          13. Carter M et al: Genetic abnormalities detected in ependymomas by comparative genomic hybridisation. Br J Cancer. 86(6):929-39, 2002
                                                                                          14. Chang UK et al: Surgical outcome and prognostic factors of spinal intramedullary ependymomas in adults. J Neurooncol. 57(2):133-9, 2002
                                                                                          15. Choi JY et al: Intracranial and spinal ependymomas: review of MR images in 61 patients. Korean J Radiol. 3(4):219-28, 2002
                                                                                          16. Hanbali F et al: Spinal cord ependymoma: radical surgical resection and outcome. Neurosurgery. 51(5):1162-72; discussion 1172-4, 2002
                                                                                          17. Jeuken JW et al: Correlation between localization, age, and chromosomal imbalances in ependymal tumours as detected by CGH. J Pathol. 197(2):238-44, 2002
                                                                                          18. Hirose Y et al: Chromosomal abnormalities subdivide ependymal tumors into clinically relevant groups. Am J Pathol. 158(3):1137-43, 2001
                                                                                          19. Koeller KK et al: Neoplasms of the spinal cord and filum terminale: radiologic-pathologic correlation. Radiographics. 20(6):1721-49, 2000
                                                                                          20. Lagares A et al: Spinal cord ependymoma presenting with acute paraplegia due to tumoral bleeding. J Neurosurg Sci. 44(2):95-7; discussion 97-8, 2000
                                                                                          21. Miyazawa N et al: MRI at 1.5 T of intramedullary ependymoma and classification of pattern of contrast enhancement. Neuroradiology. 42(11):828-32, 2000
                                                                                          22. Wiestler OD et al: Ependymoma. In Kleihues P, Cavanee WK. Pathology & Genetics of Tumors of the Central Nervous System. Lyon: IARC Press. 72-7, 2000
                                                                                          23. Graf M et al: Extraneural metastasizing ependymoma of the spinal cord. Pathol Oncol Res. 5(1):56-60, 1999
                                                                                          24. Mazewski C et al: Karyotype studies in 18 ependymomas with literature review of 107 cases. Cancer Genet Cytogenet. 113(1):1-8, 1999
                                                                                          25. Bourgouin PM et al: A pattern approach to the differential diagnosis of intramedullary spinal cord lesions on MR imaging. AJR Am J Roentgenol. 170(6):1645-9, 1998
                                                                                          26. Kahan H et al: MR characteristics of histopathologic subtypes of spinal ependymoma. AJNR Am J Neuroradiol. 17(1):143-50, 1996
                                                                                          27. Fine MJ et al: Spinal cord ependymomas: MR imaging features. Radiology. 197(3):655-8, 1995
                                                                                          28. Waldron JN et al: Spinal cord ependymomas: a retrospective analysis of 59 cases. Int J Radiat Oncol Biol Phys. 27(2):223-9, 1993
                                                                                          29. Nemoto Y et al: Intramedullary spinal cord tumors: significance of associated hemorrhage at MR imaging. Radiology. 182(3):793-6, 1992