Intramedullary spinal cord tumors (IMSCTs) pose a high risk of iatrogenic neurologic injury during resection, yet no blood-based assay is available to quantify intra-operative neuroglial damage in real time. A 36-year-old woman with a C7–T3 WHO grade II ependymoma underwent laminoplasty and microsurgical gross total resection. Peripheral blood was collected at five peri-operative time points. Spinal cord-derived cell free DNA was quantified by droplet-digital PCR, and 119-plex proteomics measured four previously validated proteins (FABP-3, REST, IL-6, NF-H). The Spinal Cord Injury Index (SCII)—a dimensionless composite generated from these analytes—was calculated at each time point. SCII increased after initial myelotomy, peaking at myelotomy completion, then returned to pre-myelotomy levels by postoperative day 1. In contrast, glial fibrillary acidic protein and neurofilament-light concentrations were lagging indicators that continued increasing after completion of myelotomy and into postoperative day 1. SCII demonstrated temporal fidelity to the patient’s neurologic trajectory and outcome. SCII may allow for high temporal fidelity, molecular monitoring that parallels surgical manipulation and precedes classical protein biomarker elevations, suggesting potential future utility as a real-time liquid biopsy for spinal-cord monitoring during neurosurgical oncology.
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