[Giant ependymoma of the cauda equina. Long-term development apropos of 7 cases]

Seven cases of giant ependymomas of cauda equina, extending from the conus medullaris to the sacrum, are reported. Mean age of the patients was 36 years. The initial symptoms were not specific, including low back pain and radiculalgias. However, in two cases, the clinical presentation was related to hydrocephalus. At the time of the operation, 6 patients presented with pain, weakness and sphincter dysfunction. The diagnosis of tumor was made after myelogram in all cases. Metrizamide enhanced CT scan has been performed in one case. None patient had preoperative magnetic resonance imaging (MRI) but MRI allowed the follow up in 5 patients and detection of local and remote recurrences in 4 cases. All the tumors were attached to the filum terminale, and unless extended from L2 to S1. Pathologically, 3 patients had tumors classified as myxopapillary and 4 of the cellular type. Two patients had gross total resection of the tumor at the initial operation. Five patients had initial biopsy to make a diagnosis and required subsequent surgery for radical excision after an average of 16.8 months. Radiation therapy has been performed in 1 case after biopsy, in 1 case after total resection (grade III) and in 2 cases after recurrences. Three patients died 1 year, 5 years, 12 years post-operatively. Among these 3 patients, 2 had recurrences. Four patients are alive. One patient has no recurrence 5 years after initial surgery. Another patient remains symptom free 7 years after surgery but MRI showed a local recurrence. The last two patients present recurrences 7 years and 8 years after surgery. These recurrences have been treated by surgical removal.(ABSTRACT TRUNCATED AT 250 WORDS)