Intracranial ependymomas in childhood: recurrence, reoperation, and outcome

Introduction: Intracranial ependymomas (IE) in children are aggressive tumors, and total resection (TR) is considered to be the most powerful predictor of outcome. The data regarding recurrent IE (RIE), in particular the role of reoperation, are scarce in the literature. Methods and results: We studied 70 cases of IE in children operated on for IE since the advent of computed imaging. TR was achieved at initial surgery in 38 out of 70 cases. After a mean follow-up of 76.1 months, 33 out of 70 tumors had progressed. Eighteen were reoperated, achieving TR in 12 out of 18 cases. The morbidity associated with reoperation was minimal, especially compared with the first operation. After a mean follow-up of 74.7 months after reoperation, 10 out of 18 patients had died of tumor progression, 1 had a stable tumor, and 7 were tumor free. When TR was achieved, the overall survival rate was 7 out of 12. Conclusion: Total resection is the only curative treatment for RIE and is often possible, especially when the initial resection was total.