Keisuke Onoda*, Anh Trần Huệ, Ryousuke Doi, Shunsuke Hatakenaka, Jumpei Kato, Tomihiro Wakamiya, Masahiro Indou, Kimihiro Nakahara, Tatsuya Tanaka, Takashi Agari, Takashi Sugawara, Kazuaki Shimoji, Eiichi Suehiro, Hiroshi Itokawa and Akira Matsuno

Department of Neurosurgery, School of Medicine, International University of Health and Welfare, Narita Hospital, Narita, Japan

*Corresponding Author: Keisuke Onoda, Department of Neurosurgery, School of Medicine, International University of Health and Welfare, Narita Hospital, Narita, Japan.

Received: March 20, 2026; Published: April 29, 2026

Abstract

Syringomyelia is frequently accompanied by intramedullary spinal ependymomas and is generally attributed to cerebrospinal fluid flow obstruction. However, the mechanisms underlying rapid syrinx progression and acute neurological deterioration remain unclear. A 29-year-old male with C6-C7 intramedullary ependymoma and syringomyelia extending to C3 was initially managed conservatively. Two years later, he presented with progressive quadriparesthesia, left-sided weakness, and respiratory dysfunction. Magnetic resonance imaging revealed rapid rostral extension of the syrinx to the medulla and a newly formed septum at the C4 level. Surgery was performed to remove the tumor and decompress the syrinx. Xanthochromic fluid was observed when the syrinx was opened. The tumor was resected via laminoplasty at the level of C3-C7 and midline myelotomy, and two syringo–subarachnoid shunts were placed. Histopathological examination confirmed a World Health Organization grade II ependymoma. The septal tissue showed fibrosis, granulation, and hemosiderin deposition, indicating repeated hemorrhage. Postoperative magnetic resonance imaging revealed near-total tumor resection and marked reduction of the syrinx, accompanied by significant neurological improvement. Repeated intratumoral hemorrhage may induce fibrous septation within tumor-associated syringomyelia, potentially altering intramedullary fluid dynamics. In this case, the septum may have functioned in a check valve–like manner, contributing to rapid rostral progression of the syrinx and neurological deterioration. Septation recognition may have implications for the timing and management of surgery.

Keywords: Spinal Ependymoma; Syringomyelia; Intramedullary Tumor; Septation

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Citation

Citation: Keisuke Onoda., et al. “Rapid Rostral Progression of Tumor-Associated Syringomyelia Associated with Hemorrhage-Induced Fibrous Septation: A Case Report". Acta Scientific Neurology 9.5 (2026): 14-18.

Copyright

Copyright: ©2026 Keisuke Onoda., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.