Ependymomas are primary CNS tumors representing 3%-6% of all CNS tumors, and 34.5% of ependymomas occur in the spine. Spinal ependymomas occur most frequently in the cervical spine. Rarely, tumor-associated syringomyelia and hematomyelia may complicate cervical spinal ependymomas. Here, the authors present a case of a 37 year-old gentleman with cervical intramedullary WHO Grade II ependymoma with hematomyelia extending cephalad to the brainstem. The authors also detail their operative procedure using the OmniGuide CO2 laser and review current literature on the management of cervical intramedullary ependymoma with tumor-associated syringomyelia and/or hematomyelia.