{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:18:50Z","timestamp":1786115930463,"version":"build-2736575974"},"reference-count":18,"publisher":"Pensoft Publishers","issue":"4","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FM"],"abstract":"<jats:p>\n                    <jats:bold>Abstract<\/jats:bold>\n                  <\/jats:p>\n                  <jats:p>Intradural extramedullary anaplastic ependymomas in the cauda equina are extremely rare. The latent period from the beginning of symptoms until diagnosis is notably shorter compared to other ependymoma subtypes. In some cases, severe neurological deficit may develop rapidly due to intratumoral hemorrhage.<\/jats:p>\n                  <jats:p>We present the case of a 36-year-old male who experienced sudden numbness in his legs, followed by an inability to move his feet. In the following days, independent walking became impossible, and he stopped urinating. At the time of admission, bilateral hypesthesia was observed across the area of L4, L5, and sacral nerve root distribution, along with clinical signs indicative of cauda equina syndrome. Enhanced magnetic resonance imaging showed the presence of an intradural extramedullary mass occupying the spinal canal in the L3\u2013S1 segment. Intraoperatively, an intradural tumor was identified between the roots of the cauda equina, with signs of intratumoral hemorrhage. The tumor was dissected free from the uninvolved surrounding nerve roots using a microsurgical technique. Following the sectioning of the filum terminale at the tumor attachment site, total tumor removal was achieved. In the postoperative period, a reduction of preoperative symptoms was noted. The patient underwent postoperative radiotherapy. The two-year follow-up demonstrated mild hypesthesia in the L5 and S1 dermatomes, reduction of the weakened plantar and dorsiflexion of the feet, and persistent bladder control impairment. Postoperative MRI revealed no evidence of recurrence.<\/jats:p>\n                  <jats:p>Anaplastic ependymomas require adjuvant radiation therapy, even after total resection and systemic neuroimaging screening for recurrence or metastases. Early detection and operative treatment aiming at gross-total removal provide patients with an improved quality of life and prolonged survival.<\/jats:p>","DOI":"10.3897\/folmed.68.e154056","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T06:17:39Z","timestamp":1785997059000},"source":"Crossref","is-referenced-by-count":0,"title":["Primary intradural extramedullary anaplastic ependymoma of the cauda equina: a rare and challenging case"],"prefix":"10.3897","volume":"68","author":[{"given":"Ivo","family":"Kehayov","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atanas","family":"Davarski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Markov","sequence":"additional","affiliation":[{"name":"Department of General and Clinical Pathology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria"},{"name":"Pulmed University Hospital, Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borislav","family":"Kitov","sequence":"additional","affiliation":[{"name":"Clinic of Neurosurgery, St George University Hospital, Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2258","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"154056_B1","doi-asserted-by":"crossref","unstructured":"Guarnieri G, Tecame M, Izzo R, et al. Multisegmental diffuse intradural extramedullary ependymoma. An extremely rare case. Neuroradiol J 2014; 27:179\u201385.","DOI":"10.15274\/NRJ-2014-10018"},{"key":"154056_B2","doi-asserted-by":"crossref","unstructured":"Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 2016; 131:803\u201320.","DOI":"10.1007\/s00401-016-1545-1"},{"key":"154056_B3","doi-asserted-by":"crossref","unstructured":"Wostrack M, Ringel F, Eicker SO, et al. Spinal ependymoma in adults: a multicenter investigation of surgical outcome and progression-free survival. J Neurosurg Spine 2018; 28(6):654\u201362.","DOI":"10.3171\/2017.9.SPINE17494"},{"key":"154056_B4","doi-asserted-by":"crossref","unstructured":"Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro-Oncol 2021; 23(8):1231\u201351.","DOI":"10.1093\/neuonc\/noab106"},{"key":"154056_B5","doi-asserted-by":"crossref","unstructured":"Swanson AA, Raghunathan A, Jenkins RB, et al. Spinal cord ependymomas with MYCN amplification show aggressive clinical behavior. J Neuropathol Exp Neurol 2019; 78(9):791\u20137.","DOI":"10.1093\/jnen\/nlz064"},{"key":"154056_B6"},{"key":"154056_B7","doi-asserted-by":"crossref","unstructured":"Montoya F, Restrepo C, Rojas LO, et al. Anaplastic ependymoma of the filum terminale A case report and review of the literature. Neuro Neurosurg 2019; 2:1\u20133.","DOI":"10.15761\/NNS.1000121"},{"key":"154056_B8"},{"key":"154056_B9"},{"key":"154056_B10","doi-asserted-by":"crossref","unstructured":"Celano E, Salehani A, Malcolm JG, et al. Spinal cord ependymoma: a review of the literature and case series of ten patients. J Neurooncol 2016; 128(3):377\u201386.","DOI":"10.1007\/s11060-016-2135-8"},{"key":"154056_B11"},{"key":"154056_B12"},{"key":"154056_B13","doi-asserted-by":"crossref","unstructured":"Liu X, Sun B, Xu Q, et al. Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients. J Neurosurg Spine 2013; 19(1):3\u201311.","DOI":"10.3171\/2013.3.SPINE12183"},{"key":"154056_B14","doi-asserted-by":"crossref","unstructured":"Kinsman MJ, Callahan JD, Hattab EM, et al. Extramedullary spinal ependymoma: a diagnostic challenge and review of the literature. Clin Neurol Neurosurg 2011; 113(8):661\u20134.","DOI":"10.1016\/j.clineuro.2011.02.021"},{"key":"154056_B15","doi-asserted-by":"crossref","unstructured":"Lin YH, Huang CI, Wong TT, et al. Treatment of spinal cord ependymomas by surgery with or without postoperative radiotherapy. J Neurooncol 2005; 71(2):205\u2013210.","DOI":"10.1007\/s11060-004-1386-y"},{"key":"154056_B16","doi-asserted-by":"crossref","unstructured":"Bertero L, Ricci AA, Tampieri C, et al. Ependymomas. Pathologica 2022; 114:436\u201346.","DOI":"10.32074\/1591-951X-817"},{"key":"154056_B17","doi-asserted-by":"crossref","unstructured":"Ghasemi DR, Sill M, Okonechnikov K, et al. MYCN amplification drives an aggressive form of spinal ependymoma. Acta Neuropathol 2019; 138:1075\u201389.","DOI":"10.1007\/s00401-019-02056-2"},{"key":"154056_B18","doi-asserted-by":"crossref","unstructured":"Swanson AA, Raghunathan A, Jenkins RB, et al. Spinal cord ependymomas with MYCN amplification show aggressive clinical behavior. 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