Spinal cord ependymomas (SCEs) represent the larger proportion of ependymomas, which are rare tumors of the central nervous system. SCEs tend to occur in adulthood, with a male preponderance, and symptoms depend on the level of the lesion.
A spinal cord ependymoma is a rare benign central nervous system (CNS) tumor that is mostly found in the spinal cord. SCEs constitute a minority of both CNS and spinal cord tumors . They are slow-growing and usually present in the fourth decade of life . The typical features arise from proliferation of abnormal tumor cells into the normal cord cells, as well as from the compressive effects of the mass . These commonly include back and neck pain, in addition to motor and sensory neurological fall out . Less often seen are bladder and gastrointestinal tract symptoms.
SCE can be classified according to the World Health Organisation (WHO) classification system, as, subependymomas, myxopapillary ependymomas, classic ependymomas, and anaplastic ependymomas  . Males are more affected than females. Furthermore, SCEs are mostly found in adults, the frequent sub-types being myxopapillary and classic . Classic SCEs affect the cervical and thoracic spine, while myxopapillary SCE develops lower down . The latter are also usually encapsulated. SCEs cause less morbidity and mortality than ependymomas that occur in the brain. SCEs consist of ependymal cells, which are glial cells of the CNS that regulate the fluid exchange between cerebrospinal fluid (CSF) and adjacent nerve cells. Their presence can further cause CSF flow obstruction. Moreover, in a few cases, metastasis through the CSF occurs .
The location of pain is dependent on the level at which the SCE forms. Tumors in the lumbar spine may produce signs such as lower back and leg pain and may be very similar to disc pathology . For most patients, pain precedes neurological complaints, sometimes by over a year, and is usually more pronounced at night . Neurological symptoms include paraesthesia, radicular pain, dysesthesia, ataxia, and numbness which may start distally and move proximally, in the lower limbs . Because of the slowly progressive nature of the tumors, presentation and diagnosis are usually at a late stage .
Cervical lesions may result in weakness and atrophy of the muscles in the arms and hands . This can occur unilaterally or bilaterally. Features of Brown-Sequard syndrome may be seen. There are a number of imaging modalities employed in the diagnosis and assessment of SCEs: