Expanded Endoscopic Endonasal Approach for Resection of Suprasellar Myxopapillary Ependymoma

Introduction: Myxopapillary ependymomas are WHO grade 2 slow-growing glial tumors that typically are found in young adults and are slightly more common in males than in females. The vast majority of these tumors are located in the lumbosacral or thoracolumbar spine. Nevertheless, these tumors have the propensity for seeding of the neuraxis.

Case Report: We report of case of 20-year-old female with diagnosis of myxopapillary ependymomas of the conus medullaris at the age of 13. Patient underwent multiple surgical and radiation therapy treatments for the spinal disease and developed intracranial dissemination of the tumor. Patient was diagnosed with a suprasellar lesion with presumed diagnosis of ependymoma. Treatment with radiation therapy was deemed unsafe due to risk of radiation toxicity to the optic apparatus. She underwent an expanded endoscopic endonasal transtubercular/planar approach for a gross total resection of the tumor.

Discussion: Ependymomas are invasive primary brain tumors with the potential to disseminate throughout the central nervous system. Maximal safe resection, adjuvant radiation therapy, and chemotherapy all play a role, depending on the age of the patient, location of the tumor, and extent of resection. Primary or secondary ependymomas at the suprasellar regions are extremely rare. Our case report shows that expanded endoscopic endonasal approach (EEA) is a good surgical route even for unusual suprasellar tumors. Anatomical knowledge and surgical strategies used in suprasellar craniopharyngiomas and meningiomas may translate to other rare suprasellar pathologies. Despite the challenges of unknown behavior of anatomical displacement and adherence to surrounding structures of a suprasellar ependymoma, EEA (transtubercular/planar) proved to be an efficient surgical approach.

Publication History

Article published online:
05 February 2024