The patient came to the clinic 18-January-2003 telling that since December-1998 suffering from back pain  with progressing ataxic gait after one year with bilateral sciatica. He underwent several times for MRI lumbar spine and all the time was diagnosed as having ependymoma of the conus medullaris. Using crutches the last year. He is limping when walking and cannot stand without crutches.

On examination: the patient is limping with exaggerated scoliotic stance with crutches. SLRS was 90 degrees without pain both sides. He has almost drop both feet and weak dorsiflexion both feet 2/5. There is hypalgesia below L1 territories.

Laminectomy D11, upper half of D12 and lower half of D10. The dura was opened and inspection of the spinal cord around the lesion, did not reveal any mass. Ependymomas are usually bluish in color, and can be detected through the external surface of the spinal cord. Using motor stimulation of the spinal cord an attempt to find the less functioning part of the spinal cord. Through this area a tiny biopsy was taken and sent for biopsy. The result was low grade astrocytoma. The dura was closed water-tightly. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound.

The patient came to the clinic 31-July-2004 with MRI done 22-July-2004 showing the same changes as before the surgery. The patient telling that the right lower limb is deteriorating. He was advised to undergo radiotherapy.

The patient then came to the clinic 16-August-2003 telling that she got numbness of the right foot the last three months, but neurologically she was free.

The patient has low grade astrocytoma with no boundaries. It is difficult to remove such lesion. Radiation could help.