OBJECTIVE AND IMPORTANCE:Tumors of the cauda equina and specifically the filum terminale are uncommon. We report the fourth case of a hemangioblastoma occurring in the filum terminale.CLINICAL PRESENTATION:This 35-year-old man presented with a 4-year history of low back pain that had been previously diagnosed as a bulging disc and exhibited severe pain in response to percussion of his lower back but was neurologically intact. He was found to have a large, enhancing mass filling the thecal sac at L2-L3.INTERVENTION:The tumor was found to be attached to the filum terminale and was cleanly dissected off en toto. Microscopically, the mass consisted of endothelial cells in addition to abundant fat-laden stromal cells and reticulum.CONCLUSION:We present a case report and a review of the literature. Our patient was the first to exhibit no radicular complaints. The diagnosis was delayed in all four cases and was not determined until the time of surgery. Complete excision offers the best chance for cure, and spinal angiography can aid in diagnosis. However, a high index of suspicion is needed for preoperative detection.