Extradural ependymoma: Diagnosis using magnetic resonance imaging

Extradural ependymomas are a non--homogeneous group of tumors located mainly in lumbosacral region, both intraspinally and extraspinally; in the latter case they can extend presacrally in the retrorectal space or retrosacrally in subcutaneous tissue. More rare cases of thoracic intraspinal or of ectopic location (mediastinum, abdomen, pelvis) have been described. Extradural ependymomas are thought to arise from ependymal remnants, mainly from coccygeal medullary vestige. Neuroimaging, particularly MRI, can help in diagnosis and surgical planning; radiological features are however non-specific and a variety of differential diagnoses can be done. Therapy is mainly surgical; a complete excision is the goal, because of the high risk of recurrence. Adjuvant therapies are generally performed but are of doubtful efficacy. Prognosis is good if radical surgery has been achieved. Recurrent or metastatic tumors carry a worse prognosis.