Myxopapillary ependymoma (MPE) is a subtype of ventricular meningioma (WHO grade I) that occurs in the lumbosacral spinal cord, mostly originating from the spinal cord conus and cauda equina. Its incidence accounts for about 13% of ventricular meningiomas. Spinal MPE is a rare spinal cord tumor, which is a difficult part of the treatment of intradural tumors because of its very tight adhesion to neural tissue, easy recurrence and spread. In November 2015, our department admitted a patient with a lumbar intradural tumor, male, 42 years old, with the main symptom of slow onset of lumbar pain without obvious cause 1 year ago, which gradually worsened and continued to the dorsal side of both legs, without sensory impairment and urinary and fecal abnormalities during the course of the disease, with the following imaging manifestations, which was considered as mucinous papillary ventricular meningioma. After completing the preoperative examination, the patient was operated under general anesthesia on November 7, 2015 by Director Shang Aijia. After general anesthesia with tracheal intubation, the patient was placed in prone position. After routine disinfection and towel laying, a skin incision was made over the L2-4 spinous process, and for complete exposure of the tumor, the L2-4 spinous process and parts of the vertebral plates on both sides were completely removed, and it was seen that the epidural fat was reduced and the dura was compressed to be thin. After incision of the dura, the tumor was found to be about 7×2×2 cm in size, grayish-white with clear borders and rich blood flow, and the exploration showed that the tumor originated from the end filaments. The tumor was separated from the cauda equina adhesions along the tumor border under the microscope, and the tumor growth points on both sides of the head and tail were found. The operation was completed with layer-by-layer sutures. The operation took a total of 2 hours and 38 minutes, with bleeding of about 50 ml. After the operation, the patient had good movement of the lower limbs and normal urination and defecation. For ventricular meningiomas below the conus of the spinal cord, regardless of their size, they should be separated extraperitoneally first. Because of the brittle texture of the tumor, caution must be exercised during the operation to reduce tumor damage and strive for complete excision to reduce the possibility of postoperative recurrence or dissemination of metastases.
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