The Open Surgery Journal

2008, 2 : 18-20
Published online 2008 February 26. DOI: 10.2174/1874300500802010018
Publisher ID: TOSJ-2-18

Hemorrhage into an Occult Spinal Ependymoma After Epidural Anesthesia

Peter G. Campbell , John K. Birknes , Ashwini D. Sharan , James S. Harrop , Alexander R. Vaccaro and John K. Ratliff
Department of Neurosurgery, Thomas Jefferson University Hospital, 909 Walnut Street, 2nd Floor, Philadelphia, Pennsylvania 19107, USA.

ABSTRACT

Summary of Background Data:

Five cases of hemorrhage into a spinal neoplasm after spinal or epidural anesthesia are reported in the literature. Presentation ranges from severe low back pain to acute cauda equina syndrome.

Methods:

A case study of a patient who hemorrhaged into an intradural, extramedullary spinal cord mass was performed. A detailed literature review is also provided.

Results:

A 27 year old female underwent epidural anesthesia for Cesarean section delivery. She presented with a 3 week history of increasing low back pain with bilateral radiculopathy. Imaging studies revealed a large hemorrhagic intradural mass compressing the lower conus medullaris and cauda equina, which operatively was confirmed to be a myxopapillary ependymoma.

Conclusions:

We report a case of hemorrhage into a previously unrecognized ependymoma after epidural anesthesia. Underlying tumors may rarely complicate regional anesthesia in the lumbar spine.

Keywords:

Ependymoma, epidural anesthesia, spinal anesthesia.