Child's Nervous System

, Volume 29, Issue 11, pp 2057–2064

Histologic grade and extent of resection are associated with survival in pediatric spinal cord ependymomas

  • Michael Safaee
  • Michael C. Oh
  • Joseph M. Kim
  • Derick Aranda
  • Phiroz E. Tarapore
  • Tene A. Cage
  • Nalin Gupta
  • Andrew T. Parsa
Original Paper



Prognostic factors affecting outcomes in pediatric spinal cord ependymomas are limited. We sought to investigate potential associations between extent of resection and histologic grade on progression-free survival (PFS) and overall survival (OS).


A comprehensive literature search was performed to identify pediatric patients who underwent surgical resection for spinal cord ependymomas. Only manuscripts with clearly defined age, tumor grade, extent of resection, and clinical follow-up were included.


A total of 80 patients were identified with a histologic distribution as follows: 36 % myxopapillary (grade I), 54 % classical (grade II), and 10 % anaplastic (grade III). There was no association between tumor grade and PFS. The only factor associated with improved PFS was gross total resection (GTR), which remained significant in a multivariate model (hazard ratio (HR) = 0.248, p = 0.022). Moreover, older age (HR = 0.818, p = 0.026), GTR (HR = 0.042, p = 0.013), and anaplastic grade (HR = 19.847, p = 0.008) demonstrated a significant association with OS in a multivariate model.


Among pediatric patients with spinal cord ependymomas, PFS did not differ across histologic grades but was prolonged among patients who underwent GTR. Age, extent of resection, and tumor grade were all significantly associated with survival.


Ependymoma Spine Pediatric Histologic grade Recurrence Survival 


  1. 1.
    Agbahiwe HC, Wharam M, Batra S, Cohen K, Terezakis SA (2013) Management of pediatric myxopapillary ependymoma: the role of adjuvant radiation. Int J Radiat Oncol Biol Phys 85:421–427PubMedCrossRefGoogle Scholar
  2. 2.
    Aktug T, Hakguder G, Sarioglu S, Akgur FM, Olguner M, Pabuccuoglu U (2000) Sacrococcygeal extraspinal ependymomas: the role of coccygectomy. J Pediatr Surg 35:515–518PubMedCrossRefGoogle Scholar
  3. 3.
    Akyurek S, Chang EL, Yu TK, Little D, Allen PK, McCutcheon I, Mahajan A, Maor MH, Woo SY (2006) Spinal myxopapillary ependymoma outcomes in patients treated with surgery and radiotherapy at M.D. Anderson Cancer Center. J Neurooncol 80:177–183PubMedCrossRefGoogle Scholar
  4. 4.
    Al-Halabi H, Montes JL, Atkinson J, Farmer JP, Freeman CR (2010) Adjuvant radiotherapy in the treatment of pediatric myxopapillary ependymomas. Pediatr Blood Cancer 55:639–643PubMedCrossRefGoogle Scholar
  5. 5.
    Allen JC, Siffert J, Hukin J (1998) Clinical manifestations of childhood ependymoma: a multitude of syndromes. Pediatr Neurosurg 28:49–55PubMedCrossRefGoogle Scholar
  6. 6.
    Amirian ES, Armstrong TS, Aldape KD, Gilbert MR, Scheurer ME (2012) Predictors of survival among pediatric and adult ependymoma cases: a study using surveillance, epidemiology, and end results data from 1973 to 2007. Neuroepidemiology 39:116–124PubMedCrossRefGoogle Scholar
  7. 7.
    Armstrong TS, Vera-Bolanos E, Bekele BN, Aldape K, Gilbert MR (2010) Adult ependymal tumors: prognosis and the M. D. Anderson Cancer Center experience. Neuro Oncol 12:862–870PubMedCrossRefGoogle Scholar
  8. 8.
    Bagley CA, Kothbauer KF, Wilson S, Bookland MJ, Epstein FJ, Jallo GI (2007) Resection of myxopapillary ependymomas in children. J Neurosurg 106:261–267PubMedGoogle Scholar
  9. 9.
    Bagley CA, Wilson S, Kothbauer KF, Bookland MJ, Epstein F, Jallo GI (2009) Long term outcomes following surgical resection of myxopapillary ependymomas. Neurosurg Rev 32:321–334, discussion 334PubMedCrossRefGoogle Scholar
  10. 10.
    Benesch M, Weber-Mzell D, Gerber NU, von Hoff K, Deinlein F, Krauss J, Warmuth-Metz M, Kortmann RD, Pietsch T, Driever PH, Quehenberger F, Urban C, Rutkowski S (2010) Ependymoma of the spinal cord in children and adolescents: a retrospective series from the HIT database. J Neurosurg Pediatr 6:137–144PubMedCrossRefGoogle Scholar
  11. 11.
    Cameron MM (1976) Surgical management of multiple neuraxial ependymomas. Case report. Eur Neurol 14:365–369PubMedCrossRefGoogle Scholar
  12. 12.
    Cervoni L, Celli P, Fortuna A, Cantore G (1994) Recurrence of spinal ependymoma. Risk factors and long-term survival. Spine (Phila Pa 1976) 19:2838–2841CrossRefGoogle Scholar
  13. 13.
    Chao ST, Kobayashi T, Benzel E, Reddy CA, Stevens GH, Prayson RA, Kalfas I, Schlenk R, Krishnaney A, Steinmetz MP, Bingaman W, Hahn J, Suh JH (2011) The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas. J Neurosurg Spine 14:59–64PubMedCrossRefGoogle Scholar
  14. 14.
    Cho JC, Miller A, Kettner NW (2009) Cervical ependymoma in a male adolescent with neck and back pain. J Manip Physiol Ther 32:695–700CrossRefGoogle Scholar
  15. 15.
    Choi GH, Oh JK, Kim TY, You NK, Lee HS, Yoon do H, Ha Y, Yi S, Kim DS, Choi JU, Kim KN (2012) The clinical features and surgical outcomes of pediatric patients with primary spinal cord tumor. Childs Nerv Syst 28:897–904PubMedCrossRefGoogle Scholar
  16. 16.
    Clover LL, Hazuka MB, Kinzie JJ (1993) Spinal cord ependymomas treated with surgery and radiation therapy. A review of 11 cases. Am J Clin Oncol 16:350–353PubMedCrossRefGoogle Scholar
  17. 17.
    Conter C, Carrie C, Bernier V, Geoffray A, Pagnier A, Gentet JC, Lellouch-Tubiana A, Chabaud S, Frappaz D (2009) Intracranial ependymomas in children: society of pediatric oncology experience with postoperative hyperfractionated local radiotherapy. Int J Radiat Oncol Biol Phys 74:1536–1542PubMedCrossRefGoogle Scholar
  18. 18.
    Di Marco A, Griso C, Pradella R, Campostrini F, Garusi GF (1988) Postoperative management of primary spinal cord ependymomas. Acta Oncol 27:371–375PubMedCrossRefGoogle Scholar
  19. 19.
    Dulai MS, Caccamo DV, Briley AL, Edwards MS, Fisher PG, Lehman NL (2010) Intramedullary papillary ependymoma with choroid plexus differentiation and cerebrospinal fluid dissemination to the brain. J Neurosurg Pediatr 5:511–517PubMedCrossRefGoogle Scholar
  20. 20.
    Duong LM, McCarthy BJ, McLendon RE, Dolecek TA, Kruchko C, Douglas LL, Ajani UA (2012) Descriptive epidemiology of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors, United States, 2004–2007. Cancer 118:4220–4227PubMedCrossRefGoogle Scholar
  21. 21.
    Engelhard HH, Villano JL, Porter KR, Stewart AK, Barua M, Barker FG, Newton HB (2010) Clinical presentation, histology, and treatment in 430 patients with primary tumors of the spinal cord, spinal meninges, or cauda equina. J Neurosurg Spine 13:67–77PubMedCrossRefGoogle Scholar
  22. 22.
    Fischer G, Mansuy L (1980) Total removal of intramedullary ependymomas: follow-up study of 16 cases. Surg Neurol 14:243–249PubMedGoogle Scholar
  23. 23.
    Fujiyama K, Kishikawa M, Fujii H, Moriyama T, Fuchigami K, Iseki M, Shinkai K (1990) Anaplastic ependymoma of the spinal cord in childhood. A case report. Acta Pathol Jpn 40:376–382PubMedGoogle Scholar
  24. 24.
    Gilbert MR, Ruda R, Soffietti R (2010) Ependymomas in adults. Curr Neurol Neurosci Rep 10:240–247PubMedCrossRefGoogle Scholar
  25. 25.
    Gomez DR, Missett BT, Wara WM, Lamborn KR, Prados MD, Chang S, Berger MS, Haas-Kogan DA (2005) High failure rate in spinal ependymomas with long-term follow-up. Neuro Oncol 7:254–259PubMedCrossRefGoogle Scholar
  26. 26.
    Goto T, Ohata K, Takami T, Nishikawa M, Nishio A, Morino M, Tsuyuguchi N, Hara M (2003) Prevention of postoperative posterior tethering of spinal cord after resection of ependymoma. J Neurosurg 99:181–187PubMedCrossRefGoogle Scholar
  27. 27.
    Grill J, Le Deley MC, Gambarelli D, Raquin MA, Couanet D, Pierre-Kahn A, Habrand JL, Doz F, Frappaz D, Gentet JC, Edan C, Chastagner P, Kalifa C (2001) Postoperative chemotherapy without irradiation for ependymoma in children under 5 years of age: a multicenter trial of the French Society of Pediatric Oncology. J Clin Oncol 19:1288–1296PubMedGoogle Scholar
  28. 28.
    Hanbali F, Fourney DR, Marmor E, Suki D, Rhines LD, Weinberg JS, McCutcheon IE, Suk I, Gokaslan ZL (2002) Spinal cord ependymoma: radical surgical resection and outcome. Neurosurgery 51:1162–1172, discussion 1172–1164PubMedCrossRefGoogle Scholar
  29. 29.
    Helseth A, Mork SJ (1989) Primary intraspinal neoplasms in Norway, 1955 to 1986. A population-based survey of 467 patients. J Neurosurg 71:842–845PubMedCrossRefGoogle Scholar
  30. 30.
    Helseth E, Due-Tonnessen B, Lote K, Skullerud K, Storm-Mathisen I, Wesenberg F, Lundar T (2001) Ependymoma in children and young adults (0–19 years): report of 25 consecutive cases. Childs Nerv Syst 17:24–30PubMedCrossRefGoogle Scholar
  31. 31.
    Horn B, Heideman R, Geyer R, Pollack I, Packer R, Goldwein J, Tomita T, Schomberg P, Ater J, Luchtman-Jones L, Rivlin K, Lamborn K, Prados M, Bollen A, Berger M, Dahl G, McNeil E, Patterson K, Shaw D, Kubalik M, Russo C (1999) A multi-institutional retrospective study of intracranial ependymoma in children: identification of risk factors. J Pediatr Hematol Oncol 21:203–211PubMedCrossRefGoogle Scholar
  32. 32.
    Hoshimaru M, Koyama T, Hashimoto N, Kikuchi H (1999) Results of microsurgical treatment for intramedullary spinal cord ependymomas: analysis of 36 cases. Neurosurgery 44:264–269PubMedCrossRefGoogle Scholar
  33. 33.
    Jaing TH, Wang HS, Tsay PK, Tseng CK, Jung SM, Lin KL, Lui TN (2004) Multivariate analysis of clinical prognostic factors in children with intracranial ependymomas. J Neurooncol 68:255–261PubMedCrossRefGoogle Scholar
  34. 34.
    Jatana KR, Jacob A, Slone HW, Ray-Chaudhury A, Welling DB (2008) Spinal myxopapillary ependymoma metastatic to bilateral internal auditory canals. Ann Otol Rhinol Laryngol 117:98–102PubMedGoogle Scholar
  35. 35.
    Johnson JM, Jessurun J, Leonard A (1999) Sacrococcygeal ependymoma: case report and review of the literature. J Pediatr Surg 34:1405–1407PubMedCrossRefGoogle Scholar
  36. 36.
    Johnson RA, Wright KD, Poppleton H, Mohankumar KM, Finkelstein D, Pounds SB, Rand V, Leary SE, White E, Eden C, Hogg T, Northcott P, Mack S, Neale G, Wang YD, Coyle B, Atkinson J, DeWire M, Kranenburg TA, Gillespie Y, Allen JC, Merchant T, Boop FA, Sanford RA, Gajjar A, Ellison DW, Taylor MD, Grundy RG, Gilbertson RJ (2010) Cross-species genomics matches driver mutations and cell compartments to model ependymoma. Nature 466:632–636PubMedCrossRefGoogle Scholar
  37. 37.
    Kabler HA, Syska BE, Springer BL, Singer JI (2008) Ependymoma as a cause of low back pain in a young healthy athlete. Pediatr Emerg Care 24:685–687PubMedCrossRefGoogle Scholar
  38. 38.
    Kaner T, Sasani M, Oktenoglu T, Solmaz B, Sarloglu AC, Ozer AF (2010) Clinical analysis of 21 cases of spinal cord ependymoma : positive clinical results of gross total resection. J Korean Neurosurg Soc 47:102–106PubMedCrossRefGoogle Scholar
  39. 39.
    Kocak Z, Garipagaoglu M, Adli M, Uzal MC, Kurtman C (2004) Spinal cord ependymomas in adults: analysis of 15 cases. J Exp Clin Cancer Res 23:201–206PubMedGoogle Scholar
  40. 40.
    Lee TT, Gromelski EB, Green BA (1998) Surgical treatment of spinal ependymoma and post-operative radiotherapy. Acta Neurochir (Wien) 140:309–313CrossRefGoogle Scholar
  41. 41.
    Lin YH, Huang CI, Wong TT, Chen MH, Shiau CY, Wang LW, Ming-Tak Ho D, Yen SH (2005) Treatment of spinal cord ependymomas by surgery with or without postoperative radiotherapy. J Neurooncol 71:205–210PubMedCrossRefGoogle Scholar
  42. 42.
    Lonjon M, Goh KY, Epstein FJ (1998) Intramedullary spinal cord ependymomas in children: treatment, results and follow-up. Pediatr Neurosurg 29:178–183PubMedCrossRefGoogle Scholar
  43. 43.
    Massimino M, Gandola L, Giangaspero F, Sandri A, Valagussa P, Perilongo G, Garre ML, Ricardi U, Forni M, Genitori L, Scarzello G, Spreafico F, Barra S, Mascarin M, Pollo B, Gardiman M, Cama A, Navarria P, Brisigotti M, Collini P, Balter R, Fidani P, Stefanelli M, Burnelli R, Potepan P, Podda M, Sotti G, Madon E (2004) Hyperfractionated radiotherapy and chemotherapy for childhood ependymoma: final results of the first prospective AIEOP (Associazione Italiana di Ematologia-Oncologia Pediatrica) study. Int J Radiat Oncol Biol Phys 58:1336–1345PubMedCrossRefGoogle Scholar
  44. 44.
    Mavroudis C, Townsend JJ, Wilson CB (1977) A metastasizing ependymoma of the cauda equina. Case report. J Neurosurg 47:771–775PubMedCrossRefGoogle Scholar
  45. 45.
    McGuire CS, Sainani KL, Fisher PG (2009) Both location and age predict survival in ependymoma: a SEER study. Pediatr Blood Cancer 52:65–69PubMedCrossRefGoogle Scholar
  46. 46.
    McGuire CS, Sainani KL, Fisher PG (2009) Incidence patterns for ependymoma: a surveillance, epidemiology, and end results study. J Neurosurg 110:725–729PubMedCrossRefGoogle Scholar
  47. 47.
    McLaughlin MP, Marcus RB Jr, Buatti JM, McCollough WM, Mickle JP, Kedar A, Maria BL, Million RR (1998) Ependymoma: results, prognostic factors and treatment recommendations. Int J Radiat Oncol Biol Phys 40:845–850PubMedCrossRefGoogle Scholar
  48. 48.
    McLendon RE, Schiffer D, Rosenblum MK, Wiestler OD, Kros JM, Korshunov A, Ng H-K (2007) World Health Organization classification of tumors of the central nervous system. IARC Press, LyonGoogle Scholar
  49. 49.
    Merchant TE, Kiehna EN, Thompson SJ, Heideman R, Sanford RA, Kun LE (2000) Pediatric low-grade and ependymal spinal cord tumors. Pediatr Neurosurg 32:30–36PubMedCrossRefGoogle Scholar
  50. 50.
    Merchant TE, Jenkins JJ, Burger PC, Sanford RA, Sherwood SH, Jones-Wallace D, Heideman RL, Thompson SJ, Helton KJ, Kun LE (2002) Influence of tumor grade on time to progression after irradiation for localized ependymoma in children. Int J Radiat Oncol Biol Phys 53:52–57PubMedCrossRefGoogle Scholar
  51. 51.
    Modena P, Lualdi E, Facchinetti F, Veltman J, Reid JF, Minardi S, Janssen I, Giangaspero F, Forni M, Finocchiaro G, Genitori L, Giordano F, Riccardi R, Schoenmakers EF, Massimino M, Sozzi G (2006) Identification of tumor-specific molecular signatures in intracranial ependymoma and association with clinical characteristics. J Clin Oncol 24:5223–5233PubMedCrossRefGoogle Scholar
  52. 52.
    Moon K, Filis AK, Cohen AR (2010) Mobile spinal ependymoma. J Neurosurg Pediatr 5:85–88PubMedCrossRefGoogle Scholar
  53. 53.
    Mork SJ, Loken AC (1977) Ependymoma: a follow-up study of 101 cases. Cancer 40:907–915PubMedCrossRefGoogle Scholar
  54. 54.
    Mork SJ, Risberg G, Krogness K (1980) Case report. Anaplastic ependymoma of the spinal cord. Neuropathol Appl Neurobiol 6:307–311PubMedCrossRefGoogle Scholar
  55. 55.
    Morris DM, Steinert HR, Wiernik PH (1983) Ineffectiveness of chemotherapy in patients with metastatic ependymoma of the cauda equina. J Surg Oncol 22:33–36PubMedCrossRefGoogle Scholar
  56. 56.
    Mridha AR, Sharma MC, Sarkar C, Suri V, Rishi A, Garg A, Suri A (2007) Myxopapillary ependymoma of lumbosacral region with metastasis to both cerebellopontine angles: report of a rare case. Childs Nerv Syst 23:1209–1213PubMedCrossRefGoogle Scholar
  57. 57.
    Nagasawa DT, Trang A, Choy W, Spasic M, Yew A, Zarinkhou G, Garcia HM, Yang I (2013) Genetic expression profiles of adult and pediatric ependymomas: molecular pathways, prognostic indicators, and therapeutic targets. Clin Neurol Neurosurg 115:388–399PubMedCrossRefGoogle Scholar
  58. 58.
    Naidu MR, Dinakar I (1989) Intramedullary mass lesions of the spinal cord. Clin Neurol Neurosurg 91:135–138PubMedCrossRefGoogle Scholar
  59. 59.
    Newton HB, Henson J, Walker RW (1992) Extraneural metastases in ependymoma. J Neurooncol 14:135–142PubMedCrossRefGoogle Scholar
  60. 60.
    Nishio S, Morioka T, Fujii K, Inamura T, Fukui M (2000) Spinal cord gliomas: management and outcome with reference to adjuvant therapy. J Clin Neurosci 7:20–23PubMedCrossRefGoogle Scholar
  61. 61.
    O’Sullivan C, Jenkin RD, Doherty MA, Hoffman HJ, Greenberg ML (1994) Spinal cord tumors in children: long-term results of combined surgical and radiation treatment. J Neurosurg 81:507–512PubMedCrossRefGoogle Scholar
  62. 62.
    Oh MC, Sayegh ET, Safaee M, Sun MZ, Kaur G, Kim JM, Aranda D, Molinaro AM, Gupta N, Parsa AT (2013) Prognosis by tumor location for pediatric spinal cord ependymomas. J Neurosurg Pediatr 11:282–288PubMedCrossRefGoogle Scholar
  63. 63.
    Ohata K, Takami T, Gotou T, El-Bahy K, Morino M, Maeda M, Inoue Y, Hakuba A (1999) Surgical outcome of intramedullary spinal cord ependymoma. Acta Neurochir (Wien) 141:341–346, discussion 346–347CrossRefGoogle Scholar
  64. 64.
    Oya N, Shibamoto Y, Nagata Y, Negoro Y, Hiraoka M (2002) Postoperative radiotherapy for intracranial ependymoma: analysis of prognostic factors and patterns of failure. J Neurooncol 56:87–94PubMedCrossRefGoogle Scholar
  65. 65.
    Payne NS 2nd, McDonald JV (1973) Rupture of spinal cord ependymoma. Case report. J Neurosurg 39:662–665PubMedCrossRefGoogle Scholar
  66. 66.
    Peker S, Ozgen S, Ozek MM, Pamir MN (2004) Surgical treatment of intramedullary spinal cord ependymomas: can outcome be predicted by tumor parameters? J Spinal Disord Tech 17:516–521PubMedCrossRefGoogle Scholar
  67. 67.
    Pica A, Miller R, Villa S, Kadish SP, Anacak Y, Abusaris H, Ozyigit G, Baumert BG, Zaucha R, Haller G, Weber DC (2009) The results of surgery, with or without radiotherapy, for primary spinal myxopapillary ependymoma: a retrospective study from the rare cancer network. Int J Radiat Oncol Biol Phys 74:1114–1120PubMedCrossRefGoogle Scholar
  68. 68.
    Prayson RA (1999) Clinicopathologic study of 61 patients with ependymoma including MIB-1 immunohistochemistry. Ann Diagn Pathol 3:11–18PubMedCrossRefGoogle Scholar
  69. 69.
    Preston-Martin S (1990) Descriptive epidemiology of primary tumors of the spinal cord and spinal meninges in Los Angeles County, 1972–1985. Neuroepidemiology 9:106–111PubMedCrossRefGoogle Scholar
  70. 70.
    Puget S, Grill J, Valent A, Bieche I, Dantas-Barbosa C, Kauffmann A, Dessen P, Lacroix L, Geoerger B, Job B, Dirven C, Varlet P, Peyre M, Dirks PB, Sainte-Rose C, Vassal G (2009) Candidate genes on chromosome 9q33-34 involved in the progression of childhood ependymomas. J Clin Oncol 27:1884–1892PubMedCrossRefGoogle Scholar
  71. 71.
    Schellinger KA, Propp JM, Villano JL, McCarthy BJ (2008) Descriptive epidemiology of primary spinal cord tumors. J Neurooncol 87:173–179PubMedCrossRefGoogle Scholar
  72. 72.
    Schiffer D, Chio A, Giordana MT, Migheli A, Palma L, Pollo B, Soffietti R, Tribolo A (1991) Histologic prognostic factors in ependymoma. Childs Nerv Syst 7:177–182PubMedCrossRefGoogle Scholar
  73. 73.
    Schiffer D (1997) Brain tumors: biology, pathology, and clinical references. Springer, BerlinCrossRefGoogle Scholar
  74. 74.
    Scott M (1974) Infiltrating ependymomas of the cauda equina. Treatment by conservative surgery plus radiotherapy. J Neurosurg 41:446–448PubMedCrossRefGoogle Scholar
  75. 75.
    Smyth MD, Horn BN, Russo C, Berger MS (2000) Intracranial ependymomas of childhood: current management strategies. Pediatr Neurosurg 33:138–150PubMedCrossRefGoogle Scholar
  76. 76.
    Stephen JH, Sievert AJ, Madsen PJ, Judkins AR, Resnick AC, Storm PB, Rushing EJ, Santi M (2012) Spinal cord ependymomas and myxopapillary ependymomas in the first 2 decades of life: a clinicopathological and immunohistochemical characterization of 19 cases. J Neurosurg Pediatr 9:646–653PubMedCrossRefGoogle Scholar
  77. 77.
    Taylor MD, Poppleton H, Fuller C, Su X, Liu Y, Jensen P, Magdaleno S, Dalton J, Calabrese C, Board J, Macdonald T, Rutka J, Guha A, Gajjar A, Curran T, Gilbertson RJ (2005) Radial glia cells are candidate stem cells of ependymoma. Cancer Cell 8:323–335PubMedCrossRefGoogle Scholar
  78. 78.
    Timmermann B, Kortmann RD, Kuhl J, Meisner C, Slavc I, Pietsch T, Bamberg M (2000) Combined postoperative irradiation and chemotherapy for anaplastic ependymomas in childhood: results of the German prospective trials HIT 88/89 and HIT 91. Int J Radiat Oncol Biol Phys 46:287–295PubMedCrossRefGoogle Scholar
  79. 79.
    Volpp PB, Han K, Kagan AR, Tome M (2007) Outcomes in treatment for intradural spinal cord ependymomas. Int J Radiat Oncol Biol Phys 69:1199–1204PubMedCrossRefGoogle Scholar
  80. 80.
    Wahab SH, Simpson JR, Michalski JM, Mansur DB (2007) Long term outcome with post-operative radiation therapy for spinal canal ependymoma. J Neurooncol 83:85–89PubMedCrossRefGoogle Scholar
  81. 81.
    Waldron JN, Laperriere NJ, Jaakkimainen L, Simpson WJ, Payne D, Milosevic M, Wong CS (1993) Spinal cord ependymomas: a retrospective analysis of 59 cases. Int J Radiat Oncol Biol Phys 27:223–229PubMedCrossRefGoogle Scholar
  82. 82.
    Wen BC, Hussey DH, Hitchon PW, Schelper RL, Vigliotti AP, Doornbos JF, VanGilder JC (1991) The role of radiation therapy in the management of ependymomas of the spinal cord. Int J Radiat Oncol Biol Phys 20:781–786PubMedCrossRefGoogle Scholar
  83. 83.
    Whitaker SJ, Bessell EM, Ashley SE, Bloom HJ, Bell BA, Brada M (1991) Postoperative radiotherapy in the management of spinal cord ependymoma. J Neurosurg 74:720–728PubMedCrossRefGoogle Scholar
  84. 84.
    Yasui T, Hakuba A, Katsuyama J, Nishimura S (1988) Microsurgical removal of intramedullary spinal cord tumours: report of 22 cases. Acta Neurochir Suppl (Wien) 43:9–12Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Michael Safaee
    • 1
  • Michael C. Oh
    • 1
  • Joseph M. Kim
    • 1
  • Derick Aranda
    • 1
  • Phiroz E. Tarapore
    • 1
  • Tene A. Cage
    • 1
  • Nalin Gupta
    • 1
    • 2
  • Andrew T. Parsa
    • 1
  1. 1.Department of Neurological SurgeryUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of PediatricsUniversity of California San FranciscoSan FranciscoUSA

Personalised recommendations