{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:31Z","timestamp":1776096391721,"version":"3.50.1"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,30]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spinal ependymomas are the most common intramedullary spinal cord tumors in adults but rarely span multiple vertebral segments. Giant intradural intramedullary spinal ependymomas are exceedingly rare and pose diagnostic and surgical challenges due to their size and location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors report the case of a 31-year-old female who presented with progressive neck pain, lower extremity weakness, and sensory deficits. MRI revealed a large intramedullary lesion extending 11 spinal levels from C1 to T4. Gross-total en bloc resection of a 16-cm intramedullary ependymoma was achieved via C1\u2013T4 laminectomy with posterior midline myelotomy, guided by multimodal intraoperative neuromonitoring. Pathological examination revealed a WHO grade 2 ependymoma. Postoperative MRI confirmed no residual tumor. The patient experienced transient postoperative motor deficits with gradual neurological recovery noted at follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case represents one of the largest reported intramedullary spinal ependymomas in the literature and demonstrates the feasibility of gross-total resection using a posterior longitudinal midline myelotomy approach. Successful management was facilitated by careful microsurgical technique and intraoperative neuromonitoring. Early recognition and timely surgical intervention are critical in optimizing outcomes in patients with spinal ependymomas; however, patients with multilevel intramedullary tumors will likely have residual neurological deficits.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25686\">https:\/\/thejns.org\/doi\/10.3171\/CASE25686<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25686","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:04:48Z","timestamp":1775642688000},"source":"Crossref","is-referenced-by-count":0,"title":["Giant intradural intramedullary spinal ependymoma: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7642-0819","authenticated-orcid":true,"given":"Esteban R.","family":"Rivera-Rivera","sequence":"first","affiliation":[{"name":"Department of Surgery, Section of Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana S.","family":"V\u00e1zquez-Medina","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camille L.","family":"Santiago-Negron","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiram","family":"Maldonado","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Estronza","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emil A.","family":"Pastrana","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Neurosurgery, University of Puerto Rico, Medical Sciences Campus, San Juan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"8","key":"bib1","series-title":"Spine J","first-page":"1325","article-title":"Epidemiology of primary malignant non-osseous spinal tumors in the United States","volume":"22","author":"Momin","year":"2022","unstructured":"Momin AAOyem PPatil NEpidemiology of primary malignant non-osseous spinal tumors in the United States. Spine J. 2022;22(8):1325-1333. doi:10.1016\/j.spinee.2022.02.015"},{"issue":"12","key":"bib2","series-title":"Neuro Oncol","first-page":"iii1","article-title":"CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2014-2018","volume":"23","author":"Ostrom","year":"2021","unstructured":"Ostrom QTCioffi GWaite KKruchko CBarnholtz-Sloan JS.CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2014-2018. Neuro Oncol. 2021;23(12)(suppl 2):iii1-iii105. doi:10.1093\/neuonc\/noab200"},{"issue":"6","key":"bib3","series-title":"J Neurosurg Spine","first-page":"654","article-title":"Spinal ependymoma in adults: a multicenter investigation of surgical outcome and progression-free survival","volume":"28","author":"Wostrack","year":"2018","unstructured":"Wostrack MRingel FEicker SOSpinal ependymoma in adults: a multicenter investigation of surgical outcome and progression-free survival. J Neurosurg Spine. 2018;28(6):654-662. doi:10.3171\/2017.9.SPINE17494"},{"key":"bib4","series-title":"World Neurosurg","first-page":"e703","article-title":"Surgical treatment of spinal ependymomas: experience in 49 patients","volume":"111","author":"Wild","year":"2018","unstructured":"Wild FHartmann CHeissler HEHong BKrauss JKNakamura M.Surgical treatment of spinal ependymomas: experience in 49 patients. 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Neuro Oncol. 2021;23(8):1231-1251. doi:10.1093\/neuonc\/noab106"},{"key":"bib7","series-title":"Front Oncol","first-page":"1301179","article-title":"Spinal ependymoma in adults: from molecular advances to new treatment perspectives","volume":"13","author":"Cerretti","year":"2023","unstructured":"Cerretti GPessina FFranceschi ESpinal ependymoma in adults: from molecular advances to new treatment perspectives. Front Oncol. 2023;13:1301179. doi:10.3389\/fonc.2023.1301179"},{"issue":"8","key":"bib8","series-title":"Curr Oncol Rep","first-page":"985","article-title":"Ependymoma: evaluation and management updates","volume":"24","author":"Rud\u00e0","year":"2022","unstructured":"Rud\u00e0 RBruno FPellerino ASoffietti R.Ependymoma: evaluation and management updates. 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