Total removal of intramedullary ependymomas: follow-up study of 16 cases

With microsurgical techniques, most intramedullary ependymomas may be totally removed. Such a complete surgical removal has been performed in 16 patients with intramedullary ependymomas. Of the 14 patients with benign tumors, 3 have no sequelae, 7 are able to walk, and 4 with preoperative paraplegia remain unchanged. The two other patients had malignant ependymomas and died within three years following surgery, in spite of chemotherapy and radiotherapy. Besides the histological and clinical factors, the prognosis depends largely on the surgical technique. The technical points that are important for locating the medullary posterior sulcus, for opening of the spinal cord, and for removal of the tumor are described.