Isolated Lumbar Spinal Nerve Root Myxopapillary Ependymoma: Case Report

Myxopapillary ependymomas comprise nearly 90% of all primary neoplasms involving the cauda equina, conus medullaris, and filum terminale. Myxopapillary ependymomas that are confined to nerve roots are exceedingly rare. We describe a young patient who presented with low back pain and radiculopathy and an intradural lesion at the L2 vertebral level. Ultimately, an intradural extramedullary tumor on the left L4 nerve root was completely resected. Pathology revealed a well-differentiated WHO Grade 1 myxopapillary ependymoma with well-defined perivascular pseudorosettes. Postoperatively, the patient had complete resolution of her symptoms and no radiographic evidence of residual or recurrent disease. Although rare, it is important to keep ependymomas in the differential for lumbosacral nerve root tumors. Surgical resection offers the patient both a definitive diagnosis and potential symptom reduction. It is also important for the surgeon to be aware that these ependymomas can be both multifocal and malignant. We present the third case ever of an ependymoma confined to a spinal nerve root.