Cauda Equina — Conus Medullaris Ependymoma

Abstract

Ependymomas of the cauda equina—conus medullaris region are often well—defined, sausage—shaped, small tumors attached to the filum terminale. These lesions are easily separable from the nerve roots and the tip of the spinal cord. On the other hand, the tumor may envelope the nerve roots and conus so that the origin of the lesion is questionable and its total removal may be impossible. Occasionally this type of tumor will reach tremendous size and exhibit marked erosion of the surrounding bony structures. When this tumor cannot be totally removed, the goal of surgery becomes decompression of the nervous elements which it surrounds. With the aid of magnification and microsurgical instruments, more neoplasm can be resected with less damage to the cord and nerve roots than was previously thought possible. In dealing with these tumors it is imperative that the blood supply to the conus is preserved. Large vessels often accompany sacral nerve roots upward to supply not only the tumor but the conus as well.