radiologically , they are similar to ependymomas , and histopathologically , they are similar to neuroendocrine tumors . most of them are non - secreting tumors , although they are of sympathetic origin . back pain is the most common symptom , and they are not associated with tachycardia , flushing , or hypertension . the treatment of choice is total surgical resection , and no additional treatment is needed with total resection . most of them are benign , but , recurrence can occur in cases involving a failure of the total resection . we describe a rare case of a paraganglioma that was adherent to the cauda equina that presented with low back pain and radiating pain in both the lower extremities . a 76-year - old female visited our department with complaints of low back pain and radiating pain in both the lower extremities for more than two months . magnetic resonance ( mr ) imaging revealed a lobulated sausage - like intradural mass ( fig . 1 ) . she underwent a total laminectomy and near - total tumor removal . during the operation , after opening the dura , a reddish , friable , and well - marginated mass was observed ( fig . we removed the mass near - totally except for the lesion that was adherent to the cauda equina . extradural paragangliomas may compress the spinal cord , resulting in paraparesis5 ) . from a pathologic point of view , paragangliomas are similar to parasympathetic tumors . however , functional paragangliomas are rare6 ) . histopathologically they are similar to parasympathetic tumors that occur in the carotid body or glomus region . althogh they are also similar to catecholamine - secreting tumors , symptoms of flushing , tachycardia , or hypertension are rare . however , a case in which hypertension was controlled after thoracic paraganglioma removal has been reported12 ) . preoperative diagnosis is difficult with radiological tools . mr images of paragangliomas in the cauda equina region are non - specific and are relatively isointense on t1-weighted images and hyperintense on t2-weighted images . immunohistochemically , neuron - specific enolase , synaptophysin , and chromogranin staining are positive2 ) . in the cauda equina region , it is very difficult to distinguish paragangliomas from ependymomas . cauda equina paragangliomas are classified as grade i on the world health organization ( who ) classification . recurrence after surgery on a paraganglioma in the cauda equina region , especially if it is encapsulated , is rarely encountered2 ) . the surgical goal is complete total resection with preservation of the surrounding nerve roots1 ) . thus , we did not treat the patient any additional therapy , and conducted a close follow - up . after incomplete surgical resection , prolonged postoperative observations are mandatory because of the slow evolution of paragangliomas4 ) . distant metastases very rarely occur5 ) , and metastatic paragangliomas of the spine have been reported7,11 ) . total resection was difficult in this case due to adhesion to the cauda equina , and close follow - up may therefore be needed .
paragangliomas are rare among intradural spinal tumors . 
 most of them are benign , but aggressive behavior and local recurrence can occur . 
 cases of paraganglioma are , difficult to diagnose radiologically ; hence , diagnosis is confirmed histopathologically . 
 radiologically , paragangliomas are similar to ependymomas , and , histopathologically , they are similar to neuroendocrine tumors . 
 we evaluated the case of a 76-year - old woman with a spinal paraganglioma that was associated with back pain and radiating pain in both the lower extremities . 
 she underwent an operation , and her symptoms were relieved . here , we describe a rare case of paraganglioma that was adherent to the cauda equina .