Intraoperative and pathological findings of intramedullary amputation neuroma associated with spinal ependymoma
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CASE REPORT
Intraoperative and pathological findings of intramedullary amputation neuroma associated with spinal ependymoma Hidetaka Arishima • Hiroaki Takeuchi Kenzo Tsunetoshi • Toshiaki Kodera • Ryuhei Kitai • Ken-ichiro Kikuta
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Received: 5 November 2012 / Accepted: 11 November 2012 / Published online: 28 November 2012 Ó The Author(s) 2012. This article is published with open access at Springerlink.com
Abstract Amputation neuromas typically arise in injured peripheral nerves; rarely, however, they arise in the spinal cord. We report a rare case of intramedullary amputation neuroma associated with ependymoma in the cervical spinal cord. A 73-year-old woman presented with a 5-year history of progressive gait disturbance. Neurological examination revealed complete motor deficit of her hands and legs. Magnetic resonance imaging of the cervical spine revealed an enhancing mass within the spinal cord at the C6/7 level. The patient underwent C5–C7 laminectomy surgery. During resection of the spinal tumor, we found a whitish string resembling an aberrant nerve root or schwannoma with adhesion to the tumor on the ventral side of the spinal cord. After resecting the tumor, the surgical specimen was cut and separated into a soft greyish tumor (spinal tumor) and the tough whitish string. Histopathological and immunohistochemical examination revealed the former was a spinal ependymoma and the latter was a neuroma. An intramedullary amputation neuroma associated with a spinal ependymoma is rare, and this is the first known case in which intraoprerative findings were clearly shown. Neurosurgeons should be aware that spinal ependymomas might coexist with neuromas. Keywords Ependymoma Intramedullary amputation neuroma Spinal cord
Introduction Amputation neuromas are non-neoplasm tangles consisting of myelinated axons and Schwann cells that sprout from the end of an injured nerve. They typically arise in the peripheral nerves; rarely, however, they arise in the central nervous system, from the spinal cord or brain stem. For example, most of those previously described were discovered in association with or without a history of trauma [1–9] and disruptive disorders, for example demyelinating disease [10, 11], syringomyelia [10], spinal tumors [10, 12], and other spinal cord or brain disease [10, 13–15]. Most small intramedullary neuromas were discovered by microscopy at autopsy [2, 4, 6, 7, 9, 10, 12, 13, 15, 16]. They were usually tiny and sometimes described as microneuromas [6, 12]. Although microscopic examinations and findings of neuromas in the spinal cord have been reported [2, 4, 7, 9–13], there have been no previous reports of macroscopic and operative findings of these lesions. We report a rare case of amputation neuroma with spinal ependymoma, report the intraoperative and pathological findings, and discuss the pathogenesis. Case report History A 73-year-old woman presenting with a 5-year history of progressive gait disturbance was referred to our hospital. She had no past history of trauma or particular disease.
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