Understanding tanycytic ependymoma: A rare subtype of ependymoma

Spinal intramedullary tanycytic ependymoma (TE) is a rare variant of ependymoma with only about 60 cases reported till date. Radiological diagnosis is tedious and identification of its unique histopathology is required for definitive diagnosis. It is often misdiagnosed solely on radiology as well as intra-operative findings. Because of its exceedingly low incidence (1% of all spinal cord neoplasms), only a small number of cases of intramedullary TE have been recorded so far. We report an adult female who presented with dorsal intramedullary TE and underwent gross total resection under intraoperative nerve monitoring. Additionally, we have also reviewed the literature already published on this entity. Subtle radiological differentiations may assist in considering TE as a differential diagnosis. Long term survival in these cases is extremely favorable. Our case depicts one of the few cases of spinal intramedullary TE known in literature and one of the very few in Southern Asian region. We highlight the challenges involved in making an accurate diagnosis of this entity radiologically and intra-operatively.