{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:36:27Z","timestamp":1791909387493,"version":"4.3.4"},"reference-count":80,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,8]]},"abstract":"\n OBJECT<\/jats:title>\n Ependymomas of the filum terminale provide specific surgical challenges due to their often enormous size, contact with nerve roots of the cauda equina and conus, and potential for subarachnoid dissemination. This study presents treatment results for these tumors over a 30-year period.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Among 1447 patients with tumors of the spinal canal treated between 1980 and 2014, 618 patients presented with extramedullary tumors. Of these, 42 patients (25 males, 17 females) demonstrated a myxopapillary ependymoma in the lumbosacral region. Thirty-four patients underwent 36 operations for 39 such tumors. The mean patient age was 38 \u00b1 14 years (range 11\u221273 years), with an average clinical history of 37 \u00b1 67 months. Patients were followed through outpatient visits and questionnaires, with a mean follow-up of 10 years (127 \u00b1 100 months). Twenty-seven operations were performed to treat de novo tumors and the remainder were undertaken on recurrent tumors. Short-term results were determined for individual symptoms, and tumor recurrence rates were calculated with Kaplan-Meier statistical analyses.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Subarachnoid dissemination was observed in 11 patients and was related to previous surgery in 9 patients and associated with extensive tumors in 2 patients. Gross-total resections (GTR) were achieved in 28 operations (77.7%) and subtotal resections in the remainder. Subtotal resections were restricted to unencapsulated ependymomas (61.5%). Radiotherapy was employed after 6 operations on unencapsulated tumors, with 5 of these also demonstrating subarachnoid seeding. Permanent surgical morbidity affected 3 patients who experienced permanent worsening of bladder function, while 7 patients showed no postoperative changes, and the remaining 26 operations were followed by improvements. Long-term outcome depended on the amount of resection and the presence of a tumor capsule. Eight of 9 tumor recurrences affected unencapsulated tumors, of which 3 had undergone GTR. The overall recurrence rates were 6.6%, 19.0%, and 37.0% after 1, 10, and 20 years, respectively. For unencapsulated ependymomas, the corresponding rates were 15.6%, 32.5%, and 66.2% after 1, 10, and 20 years, respectively, with significantly lower rates of 9.1% after 10 and 20 years for encapsulated tumors. Postoperative radiotherapy tended to prolong the recurrence-free interval for patients with unencapsulated tumors. Five patient deaths occurred during follow-up, of which 2 deaths were tumor related and occurred at 216 and 287 months after surgery.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n Extramedullary ependymomas are slow-growing tumors in the lumbosacral region, sometimes with an indolent course for long periods of time. Despite their delicate location and often enormous size, surgical morbidity in experienced hands is low, with good chances for postoperative clinical improvements and very low recurrence rates after GTR for encapsulated tumors. The role of postoperative radiotherapy remains controversial. Radiotherapy may be considered after incomplete resections of unencapsulated tumors and\/or for patients with subarachnoid dissemination.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.5.focus15151","type":"journal-article","created":{"date-parts":[[2015,8,1]],"date-time":"2015-08-01T03:39:09Z","timestamp":1438400349000},"page":"E7","source":"Crossref","is-referenced-by-count":47,"title":["Spinal ependymomas. Part 2: Ependymomas of the filum terminale"],"prefix":"10.3171","volume":"39","author":[{"given":"J\u00f6rg","family":"Klekamp","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Christliches Krankenhaus, Quakenbr\u00fcck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15151","series-title":"Int J Radiat Oncol Biol Phys","first-page":"421","article-title":"Management of pediatric myxopapillary ependymoma: the role of adjuvant radiation","volume":"85","author":"Agbahiwe","year":"2013"},{"key":"b2-focus15151","series-title":"J Neurooncol","first-page":"177","article-title":"Spinal myxopapillary ependymoma outcomes in patients treated with surgery and radiotherapy at M.D. Anderson Cancer Center","volume":"80","author":"Akyurek","year":"2006"},{"key":"b3-focus15151","series-title":"Spinal Cord","first-page":"1073","article-title":"Myxopapillary ependymoma: correlation of clinical and imaging features with surgical respectability in a series with long-term follow-up","volume":"49","author":"Al-Habib","year":"2011"},{"key":"b4-focus15151","series-title":"Pediatr Blood Cancer","first-page":"639","article-title":"Adjuvant radiotherapy in the treatment of pediatric myxopapillary ependymomas","volume":"55","author":"Al-Halabi","year":"2010"},{"key":"b5-focus15151","series-title":"Asian Spine J","first-page":"68","article-title":"Multi-focal myxopapillary ependymoma in the lumbar and sacral regions requiring cranio-spinal radiation therapy: a case report","volume":"5","author":"Andoh","year":"2011"},{"key":"b6-focus15151","series-title":"Neurosurg Rev","first-page":"321","article-title":"Long term outcomes following surgical resection of myxopapillary ependymomas","volume":"32","author":"Bagley","year":"2009"},{"key":"b7-focus15151","series-title":"Childs Nerv Syst","first-page":"2017","article-title":"Spinal cord ependymomas in children and adolescents","volume":"28","author":"Benesch","year":"2012"},{"key":"b8-focus15151","series-title":"Neurosurgery","first-page":"302","article-title":"Surgery for spinal cord ependymomas: outcome and prognostic factors","volume":"68","author":"Bostr\u00f6m","year":"2011"},{"key":"b9-focus15151","series-title":"Acta Neurochir (Wien)","first-page":"99","article-title":"Ependymoma of the filum terminale: treatment and prognostic factors in a series of 28 cases","volume":"124","author":"Celli","year":"1993"},{"key":"b10-focus15151","series-title":"J Neurosurg Spine","first-page":"59","article-title":"The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas","volume":"14","author":"Chao","year":"2011"},{"key":"b11-focus15151","series-title":"Surg Neurol Int","first-page":"76","article-title":"Ependymomas of the fllum terminale: The role of surgery and radiotherapy","volume":"3","author":"de Jong","year":"2012"},{"key":"b12-focus15151","series-title":"J Neurosurg Spine","first-page":"471","article-title":"Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children: a systematic review","volume":"19","author":"Feldman","year":"2013"},{"key":"b13-focus15151","series-title":"J Neurosurg Sci","first-page":"327","article-title":"Evidence-based review and guidelines for the management of myxopapillary and intramedullary ependymoma","volume":"57","author":"Figueiredo","year":"2013"},{"key":"b14-focus15151","series-title":"Oncol Rep","first-page":"2079","article-title":"Radiotherapy for partially resected spinal ependymomas: a retrospective study of 60 cases","volume":"10","author":"Gilhuis","year":"2003"},{"key":"b15-focus15151","series-title":"J Neurosurg Spine","first-page":"652","article-title":"Acute para-paresis from hemorrhagic spinal ependymoma: diagnostic dilemma and surgical management. Report of two cases and review of the literature","volume":"7","author":"Heuer","year":"2007"},{"key":"b16-focus15151","series-title":"J Neurosurg Spine","first-page":"65","article-title":"Multifocal intradural extramedullary ependymoma. Case report","volume":"14","author":"Iunes","year":"2011"},{"key":"b17-focus15151","series-title":"J Am Stat Assoc","first-page":"457","article-title":"Nonparametric estimation from incomplete observations","volume":"53","author":"Kaplan","year":"1958"},{"key":"b18-focus15151","series-title":"Childs Nerv Syst","first-page":"149","article-title":"Craniospinal dissemination of fllum myxopapillary ependymoma following spinal trauma: case report and literature review","volume":"29","author":"Khalatbari","year":"2013"},{"key":"b19-focus15151","series-title":"J Neurosurg Spine","first-page":"12","article-title":"Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results","volume":"19","author":"Klekamp","year":"2013"},{"key":"b20-focus15151","series-title":"Acta Neurochir (Wien)","first-page":"221","article-title":"Introduction of a score system for the clinical evaluation of patients with spinal 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retrospective multicenter study by the Korea Spinal Oncology Research Group","volume":"15","author":"Lee","year":"2013"},{"key":"b26-focus15151","series-title":"Neurochirurgie","first-page":"423","article-title":"Factors influencing recurrence and role of radiotherapy in filum terminale ependymomas. 14 cases and review of the literature","volume":"47","author":"Lonjon","year":"2001"},{"key":"b27-focus15151","series-title":"Neuroradiology","first-page":"828","article-title":"MRI at 1.5 T of intramedullary ependymoma and classification of pattern of contrast enhancement","volume":"42","author":"Miyazawa","year":"2000"},{"key":"b28-focus15151","series-title":"Spine (Phila Pa 1976)","first-page":"E756","article-title":"Long-term surgical outcomes for myxopapillary ependymomas of the cauda equina","volume":"34","author":"Nakamura","year":"2009"},{"key":"b29-focus15151","series-title":"Neuro Oncol","first-page":"208","article-title":"Adjuvant radiotherapy delays recurrence following subtotal resection of spinal cord ependymomas","volume":"15","author":"Oh","year":"2013"},{"key":"b30-focus15151","series-title":"J Clin Neurosci","first-page":"1390","article-title":"Spinal ependymomas: benefits of extent of resection for different histological grades","volume":"20","author":"Oh","year":"2013"},{"key":"b31-focus15151","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1114","article-title":"The results of surgery, with or without radiotherapy, for primary spinal myxopapillary ependymoma: a retrospective study from the rare cancer network","volume":"74","author":"Pica","year":"2009"},{"key":"b32-focus15151","series-title":"J Neurosurg Spine","first-page":"154","article-title":"Giant destructive myxopapillary ependymomas of the sacrum","volume":"12","author":"Quraishi","year":"2010"},{"key":"b33-focus15151","series-title":"Brain Pathol","first-page":"584","article-title":"Histological predictors of outcome in ependymoma are dependent on anatomic site within the central nervous system","volume":"2","author":"Raghunathan","year":"2013"},{"key":"b34-focus15151","series-title":"Spine (Phila Pa 1976)","first-page":"1619","article-title":"Spinal myxopapillary ependymoma: neurological deterioration in patients treated with surgery","volume":"34","author":"Sakai","year":"2009"},{"key":"b35-focus15151","series-title":"Neurosurgery","first-page":"202","article-title":"Ependymoma of the cauda equina region: diagnosis, treatment, and outcome in 15 patients","volume":"30","author":"Schweitzer","year":"1992"},{"key":"b36-focus15151","series-title":"Br J Neurosurg","first-page":"691","article-title":"Disseminated spinal myxopapillary ependymoma in an adult at initial presentation: a case report and review of the literature","volume":"28","author":"Straus","year":"2014"},{"key":"b37-focus15151","series-title":"Spine (Phila Pa 1976)","first-page":"E502","article-title":"Spontaneous hemorrhage of a spinal ependymoma: a rare cause of acute cauda equina syndrome: a case report","volume":"29","author":"Tait","year":"2004"},{"key":"b38-focus15151","series-title":"J Neurosurg Spine","first-page":"335","article-title":"Conus medullaris and cauda equina tumors: clinical presentation, prognosis, and outcome after surgical treatment: clinical article","volume":"20","author":"Wostrack","year":"2014"},{"key":"b39-focus15151","series-title":"CNS Neurosci Ther","first-page":"131","article-title":"Surgery for primary filum terminale ependymomas: outcome and prognostic factors","volume":"20","author":"Xie","year":"2014"},{"key":"b40-focus15151","series-title":"Childs Nerv Syst","first-page":"1203","article-title":"Imaging of ependymomas: MRI and CT","volume":"25","author":"Yuh","year":"2009"},{"key":"b1-focus15151","series-title":"Int J Radiat Oncol Biol Phys","first-page":"421","article-title":"Management of pediatric myxopapillary ependymoma: the role of adjuvant radiation","volume":"85","author":"Agbahiwe","year":"2013"},{"key":"b2-focus15151","series-title":"J Neurooncol","first-page":"177","article-title":"Spinal myxopapillary ependymoma outcomes in patients treated with surgery and radiotherapy at M.D. Anderson Cancer Center","volume":"80","author":"Akyurek","year":"2006"},{"key":"b3-focus15151","series-title":"Spinal Cord","first-page":"1073","article-title":"Myxopapillary ependymoma: correlation of clinical and imaging features with surgical respectability in a series with long-term follow-up","volume":"49","author":"Al-Habib","year":"2011"},{"key":"b4-focus15151","series-title":"Pediatr Blood Cancer","first-page":"639","article-title":"Adjuvant radiotherapy in the treatment of pediatric myxopapillary ependymomas","volume":"55","author":"Al-Halabi","year":"2010"},{"key":"b5-focus15151","series-title":"Asian Spine J","first-page":"68","article-title":"Multi-focal myxopapillary ependymoma in the lumbar and sacral regions requiring cranio-spinal radiation therapy: a case report","volume":"5","author":"Andoh","year":"2011"},{"key":"b6-focus15151","series-title":"Neurosurg Rev","first-page":"321","article-title":"Long term outcomes following surgical resection of myxopapillary ependymomas","volume":"32","author":"Bagley","year":"2009"},{"key":"b7-focus15151","series-title":"Childs Nerv Syst","first-page":"2017","article-title":"Spinal cord ependymomas in children and adolescents","volume":"28","author":"Benesch","year":"2012"},{"key":"b8-focus15151","series-title":"Neurosurgery","first-page":"302","article-title":"Surgery for spinal cord ependymomas: outcome and prognostic factors","volume":"68","author":"Bostr\u00f6m","year":"2011"},{"key":"b9-focus15151","series-title":"Acta Neurochir (Wien)","first-page":"99","article-title":"Ependymoma of the filum terminale: treatment and prognostic factors in a series of 28 cases","volume":"124","author":"Celli","year":"1993"},{"key":"b10-focus15151","series-title":"J Neurosurg Spine","first-page":"59","article-title":"The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas","volume":"14","author":"Chao","year":"2011"},{"key":"b11-focus15151","series-title":"Surg Neurol Int","first-page":"76","article-title":"Ependymomas of the fllum terminale: The role of surgery and radiotherapy","volume":"3","author":"de Jong","year":"2012"},{"key":"b12-focus15151","series-title":"J Neurosurg Spine","first-page":"471","article-title":"Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children: a systematic review","volume":"19","author":"Feldman","year":"2013"},{"key":"b13-focus15151","series-title":"J Neurosurg Sci","first-page":"327","article-title":"Evidence-based review and guidelines for the management of myxopapillary and intramedullary ependymoma","volume":"57","author":"Figueiredo","year":"2013"},{"key":"b14-focus15151","series-title":"Oncol Rep","first-page":"2079","article-title":"Radiotherapy for partially resected spinal ependymomas: a retrospective study of 60 cases","volume":"10","author":"Gilhuis","year":"2003"},{"key":"b15-focus15151","series-title":"J Neurosurg Spine","first-page":"652","article-title":"Acute para-paresis from hemorrhagic spinal ependymoma: diagnostic dilemma and surgical management. Report of two cases and review of the literature","volume":"7","author":"Heuer","year":"2007"},{"key":"b16-focus15151","series-title":"J Neurosurg Spine","first-page":"65","article-title":"Multifocal intradural extramedullary ependymoma. Case report","volume":"14","author":"Iunes","year":"2011"},{"key":"b17-focus15151","series-title":"J Am Stat Assoc","first-page":"457","article-title":"Nonparametric estimation from incomplete observations","volume":"53","author":"Kaplan","year":"1958"},{"key":"b18-focus15151","series-title":"Childs Nerv Syst","first-page":"149","article-title":"Craniospinal dissemination of fllum myxopapillary ependymoma following spinal trauma: case report and literature review","volume":"29","author":"Khalatbari","year":"2013"},{"key":"b19-focus15151","series-title":"J Neurosurg Spine","first-page":"12","article-title":"Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results","volume":"19","author":"Klekamp","year":"2013"},{"key":"b20-focus15151","series-title":"Acta Neurochir (Wien)","first-page":"221","article-title":"Introduction of a score system for the clinical evaluation of patients with spinal processes","volume":"123","author":"Klekamp","year":"1993"},{"key":"b21-focus15151","series-title":"Surgery of Spinal Tumors","author":"Klekamp","year":"2007"},{"key":"b22-focus15151","series-title":"Syringomyelia - Diagnosis and Treatment","author":"Klekamp","year":"2001"},{"issue":"1 Suppl Operative","key":"b23-focus15151","series-title":"Neurosurgery","first-page":"90","article-title":"Surgical technique and outcomes in the treatment of spinal cord ependymomas: part II: myxopapillary ependymoma","volume":"68","author":"Kucia","year":"2011"},{"key":"b24-focus15151","series-title":"Surg Neurol Int","first-page":"102","article-title":"Multicentric extramedullary myxopapillary ependymomas: Two case reports and literature review","volume":"3","author":"Landriel","year":"2012"},{"key":"b25-focus15151","series-title":"Neuro Oncol","first-page":"921","article-title":"Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea Spinal Oncology Research Group","volume":"15","author":"Lee","year":"2013"},{"key":"b26-focus15151","series-title":"Neurochirurgie","first-page":"423","article-title":"Factors influencing recurrence and role of radiotherapy in filum terminale ependymomas. 14 cases and review of the literature","volume":"47","author":"Lonjon","year":"2001"},{"key":"b27-focus15151","series-title":"Neuroradiology","first-page":"828","article-title":"MRI at 1.5 T of intramedullary ependymoma and classification of pattern of contrast enhancement","volume":"42","author":"Miyazawa","year":"2000"},{"key":"b28-focus15151","series-title":"Spine (Phila Pa 1976)","first-page":"E756","article-title":"Long-term surgical outcomes for myxopapillary ependymomas of the cauda equina","volume":"34","author":"Nakamura","year":"2009"},{"key":"b29-focus15151","series-title":"Neuro Oncol","first-page":"208","article-title":"Adjuvant radiotherapy delays recurrence following subtotal resection of spinal cord ependymomas","volume":"15","author":"Oh","year":"2013"},{"key":"b30-focus15151","series-title":"J Clin Neurosci","first-page":"1390","article-title":"Spinal ependymomas: benefits of extent of resection for different histological grades","volume":"20","author":"Oh","year":"2013"},{"key":"b31-focus15151","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1114","article-title":"The results of surgery, with or without radiotherapy, for primary spinal myxopapillary ependymoma: a retrospective study from the rare cancer network","volume":"74","author":"Pica","year":"2009"},{"key":"b32-focus15151","series-title":"J Neurosurg Spine","first-page":"154","article-title":"Giant destructive myxopapillary ependymomas of the sacrum","volume":"12","author":"Quraishi","year":"2010"},{"key":"b33-focus15151","series-title":"Brain Pathol","first-page":"584","article-title":"Histological predictors of outcome in ependymoma are dependent on anatomic site within the central nervous system","volume":"2","author":"Raghunathan","year":"2013"},{"key":"b34-focus15151","series-title":"Spine (Phila Pa 1976)","first-page":"1619","article-title":"Spinal myxopapillary ependymoma: neurological deterioration in patients treated with surgery","volume":"34","author":"Sakai","year":"2009"},{"key":"b35-focus15151","series-title":"Neurosurgery","first-page":"202","article-title":"Ependymoma of the cauda equina region: diagnosis, treatment, and outcome in 15 patients","volume":"30","author":"Schweitzer","year":"1992"},{"key":"b36-focus15151","series-title":"Br J Neurosurg","first-page":"691","article-title":"Disseminated spinal myxopapillary ependymoma in an adult at initial presentation: a case report and review of the literature","volume":"28","author":"Straus","year":"2014"},{"key":"b37-focus15151","series-title":"Spine (Phila Pa 1976)","first-page":"E502","article-title":"Spontaneous hemorrhage of a spinal ependymoma: a rare cause of acute cauda equina syndrome: a case report","volume":"29","author":"Tait","year":"2004"},{"key":"b38-focus15151","series-title":"J Neurosurg Spine","first-page":"335","article-title":"Conus medullaris and cauda equina tumors: clinical presentation, prognosis, and outcome after surgical treatment: clinical article","volume":"20","author":"Wostrack","year":"2014"},{"key":"b39-focus15151","series-title":"CNS Neurosci Ther","first-page":"131","article-title":"Surgery for primary filum terminale ependymomas: outcome and prognostic factors","volume":"20","author":"Xie","year":"2014"},{"key":"b40-focus15151","series-title":"Childs Nerv Syst","first-page":"1203","article-title":"Imaging of ependymomas: MRI and CT","volume":"25","author":"Yuh","year":"2009"}],"container-title":["Neurosurgical 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