Preoperative T2-weighted noncontrast volumetric magnetic resonance imaging sagittal sequence of the cervical spine demonstrates a giant intradural intramedullary expansile subependymoma (top left image). The two images on the right are preoperative sagittal diffusion tensor imaging through the brainstem (bottom) with 3-dimensional reconstruction (top) both showing the positioning of spinal long tracts in relation to a large intramedullary cervicomedullary junction tumor. The intraoperative photo at the bottom left shows the identification of safe zones for tumor entry to establish dissection planes along the tumor-parenchyma interface in the resection of a giant intramedullary cervicomedullary subependymoma.