{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T14:43:59Z","timestamp":1794321839724,"version":"4.9.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"20","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"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":[[2026,5,18]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Intradural extramedullary anaplastic ependymomas are rare, aggressive spinal tumors for which optimal management strategies remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>This case describes ongoing survival at 35 months in a 65-year-old male with an intradural extramedullary anaplastic ependymoma treated with subtotal resection and proton beam therapy. MRI revealed a T2\u20133 dorsal intradural extramedullary lesion with leptomeningeal spread in the lumbar spine. Subtotal resection was performed due to dense adherence to the cord, with approximately 10% tumor left in situ. Pathological evaluation confirmed MYCN-amplified WHO grade 3 ependymoma. Adjuvant proton beam therapy was initiated within 2 weeks of surgery, consisting of craniospinal irradiation (3600 cGy in 20 fractions) followed by a boost to a total of 5400 cGy in 30 fractions. Postoperative recovery included full return of strength and function. Serial brain and spine MRI studies at 6, 12, 18, and 22 months showed stable spinal dissemination with no intracranial spread.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case supports the role of subtotal resection followed by proton beam therapy as a viable treatment strategy for MYCN-amplified intradural extramedullary anaplastic ependymomas, particularly when gross-total resection is contraindicated.<\/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\/CASE25804\">https:\/\/thejns.org\/doi\/10.3171\/CASE25804<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25804","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:56:37Z","timestamp":1779108997000},"source":"Crossref","is-referenced-by-count":1,"title":["A rare case of intradural extramedullary anaplastic ependymoma: a 35-month survival update following resection and adjuvant proton beam radiation therapy. Illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9729-9122","authenticated-orcid":true,"given":"Bahie","family":"Ezzat","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tirone","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah M.","family":"Nichols","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7068-5517","authenticated-orcid":true,"given":"Timothy E.","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislav","family":"Lazarev","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianne","family":"Boylan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8","key":"bib1","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. Curr Oncol Rep. 2022;24(8):985-993. doi:10.1007\/s11912-022-01260-w"},{"issue":"8","key":"bib2","series-title":"Neuro Oncol","first-page":"1231","article-title":"The 2021 WHO Classification of Tumors of the Central Nervous System: a summary","volume":"23","author":"Louis","year":"2021","unstructured":"Louis DNPerry AWesseling PThe 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021;23(8):1231-1251. doi:10.1093\/neuonc\/noab106"},{"issue":"4","key":"bib3","series-title":"J Neurosurg","first-page":"725","article-title":"Incidence patterns for ependymoma: a surveillance, epidemiology, and end results study","volume":"110","author":"McGuire","year":"2009","unstructured":"McGuire CSSainani KLFisher PG.Incidence patterns for ependymoma: a surveillance, epidemiology, and end results study. J Neurosurg. 2009;110(4):725-729. doi:10.3171\/2008.9.JNS08117"},{"key":"bib4","series-title":"Front Oncol","article-title":"Primary spinal anaplastic ependymoma: a single-institute retrospective cohort and systematic review","volume":"13","author":"Wu","year":"2023","unstructured":"Wu LWang LZou WYang JJia WXu Y.Primary spinal anaplastic ependymoma: a single-institute retrospective cohort and systematic review. Front Oncol. 2023;13:1083085. doi:10.3389\/fonc.2023.1083085"},{"issue":"6","key":"bib5","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. 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J Orthop Sci. 2018;23(4):614-621. doi:10.1016\/j.jos.2018.03.004"},{"issue":"12","key":"bib13","series-title":"J Clin Oncol","first-page":"974","article-title":"Conformal radiation therapy for pediatric ependymoma, chemotherapy for incompletely resected ependymoma, and observation for completely resected, supratentorial ependymoma","volume":"37","author":"Merchant","year":"2019","unstructured":"Merchant TEBendel AESabin NDConformal radiation therapy for pediatric ependymoma, chemotherapy for incompletely resected ependymoma, and observation for completely resected, supratentorial ependymoma. 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J Orthop Sci. 2018;23(4):614-621. doi:10.1016\/j.jos.2018.03.004"},{"issue":"12","key":"bib13","series-title":"J Clin Oncol","first-page":"974","article-title":"Conformal radiation therapy for pediatric ependymoma, chemotherapy for incompletely resected ependymoma, and observation for completely resected, supratentorial ependymoma","volume":"37","author":"Merchant","year":"2019","unstructured":"Merchant TEBendel AESabin NDConformal radiation therapy for pediatric ependymoma, chemotherapy for incompletely resected ependymoma, and observation for completely resected, supratentorial ependymoma. 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Am J Surg Pathol. 2021;45(7):979-987. doi:10.1097\/PAS.0000000000001669"},{"issue":"3","key":"bib20","series-title":"J Neurooncol","first-page":"437","article-title":"Clinical presentation and extent of resection impacts progression-free survival in spinal ependymomas","volume":"167","author":"Davison","year":"2024","unstructured":"Davison MALilly DTPatel AAClinical presentation and extent of resection impacts progression-free survival in spinal ependymomas. J Neurooncol. 2024;167(3):437-446. doi:10.1007\/s11060-024-04623-4"},{"issue":"7","key":"bib21","series-title":"Neurol Res","first-page":"650","article-title":"Predictors of survival in patients with spinal ependymoma","volume":"37","author":"Lin","year":"2015","unstructured":"Lin YSmith ZAWong APMelkonian SHarris DALam S.Predictors of survival in patients with spinal ependymoma. 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