Sacrococcygeal extraspinal ependymomas:: The role of coccygectomy

Background: Ependymomas, the common glial tumors of the spinal cord, occur occasionally outside the central nervous system and are called exstraspinal ependymomas (EEP). EEPs are found primarily in sacrococcygeal region during childhood. The pathogenesis and the treatment of the sacrococcygeal (SC) ependymomas are still controversial, Therefore, we present our case with metaanalysis of other case reports to determine the optimal treatment modality for SC EEPs. Methods: A metaanalysis of case reports of SC EEPs, including the current case, was conducted. Also all available case reports of EEPs, without age limit, were analyzed to determine the distribution of EEPs localization. Results: EEPs usually are found in teratoma localizations such as the SC area, ovary, paraovarian structures, and astinum. The distribution of EEPs localization differs with age. Local recurrence rate of EEPs after coccyx excision is zero, however, it increases to 71% when the coccyx was left behind. Conclusion: The identical clinical characteristics of the SC teratomas and EEPs imply that the SC EEPs may be monophasic teratomas as their ovarian counterparts are named. Coccyx excision is an important part of the surgical treatment of these tumors, with an apparent decrease in the recurrence rate. Copyright (C) 2000 by W.B. Saunders Company.