Ependymoma is the most common intramedullary tumor. Myxo-papillary ependymoma is a slow-growing glioma that is mostly found at the conus medullaris, filum terminale, and cauda equina regions (Figure 11-24). In patients over 50 years of age ependymomas tend to develop in the thoracic region. Astrocytoma tends to affect children and young adults. Infrequently, other intramedullary tumors such as lipoma, metastasis, or hemangioblastoma are encountered.
Intramedullary gliomas usually become symptomatic in the third and fourth decades and are most often seen in the upper thoracic and cervical regions. They usually present with slow-onset myelopathy. Ependymomas tend to occur in the fourth and fifth decades, affect both genders, and in over 50% of cases are located in the thoracic spine. The initial presentation may include dysesthesia and pain and may be followed by gait dysfunction, weakness, atrophy, and myelo-pathic symptoms. Because these tumors are slow-growing they tend to be diagnosed late and by that time cause significant morbidity.
Plain films in patients with longstanding intramedullary lesions such as ependymomas may show enlarged spinal canal with increased
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