Spinal Metastasis from Subcutaneous Sacrococcygeal Ependymoma: A Case Report with Long-Term Follow-Up.

To present a previously unreported patient with recurrent spinal metastasis from subcutaneous sacrococcygeal ependymoma who was followed for 16 years.  A 50-year-old man who had T9 metastasis from subcutaneous sacrococcygeal ependymoma underwent piecemeal total T9 excision at a local hospital. He was referred to our institute because of weakness in both legs and bowel-bladder dysfunction with the presence of recurrent spinal metastasis at levels T9-T11. Additional tumor excision was performed circumferentially around the dura, along with spinal reconstruction via a posterior-anterior-posterior approach. Subsequently, the patient could walk again. Thereafter, this patient was treated by repeated surgical resection, reinstrumentation, and bone grafting for thoracic spinal metastases, and an additional 14 thoracic nerve root transections (bilateral T6-T12) as a result of eight operations.  These repeated operations have prevented paralysis and allowed the patient to maintain activities of daily living for 16 years.  We illustrated the feasibility of repeated surgical resection of thoracic spinal metastases, involving eight operations over 16 years. We believe that this case emphasizes the need to repeatedly resect this type of tumor before the onset of paralysis to maintain normal activity levels.