Intracranial ependymomas in childhood: a report of 24 cases followed for 5 years.

The management and outcome of 24 patients with intracranial ependymomas admitted to our institution between January 1979 and May 1988 have been analysed. Four patients out of the ten with infratentorial ependymomas who underwent a visible total resection were alive and free of disease at 5 years, whereas all those who had had an incomplete resection were dead. The prognosis in the supratentorial group was worse; only one patient out of seven was alive and free of disease at 5 years. Nine patients (six infratentorial and three supratentorial ependymomas) were investigated with myelography for occult spinal metastases, and apart from one who had a direct extension of an infratentorial tumour into the upper cervical spine, none had detectable metastases. Eight patients with infratentorial tumours underwent a ventriculo-peritoneal shunt insertion, and in three of them this followed a visible total resection of the tumour. Comparison of our results with those from other series suggests that any improvement in outlook is related primarily to an increased number of children surviving their initial surgical treatment, rather than to better methods of postoperative tumour control.