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Spinal ependymomas are slow-growing intramedullary tumors arising from ependymal cells lining the central canal of the spinal cord.

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They are the most common intramedullary tumor in adults (2nd most common in children)

Epidemiology

Feature	Details
Age group	Adults (30–50 years)
Sex	No significant gender predilection
Incidence	Most common spinal cord tumor in adults (~60% of intramedullary tumors)
Pediatric counterpart	Less common in children compared to astrocytomas

Classification

WHO classification:

Grade	Subtype	Characteristics
Grade I	‣	Found in conus medullaris, filum terminale, or cauda equina
Grade II	Classic ependymoma	Most common spinal form
Grade III	Anaplastic ependymoma	Rare, aggressive, seen in pediatric patients

Common locations:

They can occur at any spinal level but are most frequently found in the cervical and thoracic cord or conus medullaris.

Location	Details
Cervical spine	Most frequent in adults
Thoracic spine	Second most common
Conus medullaris/filum terminale	Typical site for myxopapillary subtype
Central canal	Originates from ependymal lining

Clinical features

Symptoms	Mechanism
Back or radicular pain	Local tumor irritation or nerve root compression
Motor weakness	UMN signs if intramedullary
Sensory loss	Dissociated sensory level, paresthesia
Bowel/bladder dysfunction	Especially if lesion in conus
Gait disturbance	Due to long tract involvement

Slow-growing, often diagnosed late after significant cord dysfunction.

Radiology

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Typically centrally located well-defined lesion with associated features such as Hemosiderin cap sign and polar cystic dilatation (syringohydromyelia)

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MR sequence	Imaging features
T1	• Iso- to hypointense
• May show intratumoral hemorrhage (hyperintense foci)
T2	• Hyperintense, centrally located lesion with cord expansion
• Often spans 3–5 vertebral levels
• Associated rostral and caudal polar cysts are common
Contrast	• Strong and homogeneous enhancement (classic)
• May be heterogeneous if hemorrhage or necrosis is present
GRE/SWI	Shows blooming due to hemosiderin (cap sign) — a classic feature