XXXX . Part 2: Ependymomas of the filum terminale.

@entity1 @entity424 @entity1494 @entity510 @entity5 @entity204
OBJECT 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 @entity510 . This study presents treatment results for these @entity5 over a 30-year period. METHODS Among 1447 @entity1 with @entity5 of the spinal canal treated between 1980 and 2014, 618 @entity1 presented with extramedullary @entity5 . Of these, 42 @entity1 (25 males, 17 females) demonstrated a @entity424 in the lumbosacral region. Thirty-four @entity1 underwent 36 operations for 39 such @entity5 . The mean @entity1 age was 38    14 years (range 11-73 years), with an average clinical history of 37    67 months. @entity1 were followed through outpatient visits and questionnaires, with a mean follow-up of 10 years (127    100 months). Twenty-seven operations were performed to treat de novo @entity5 and the remainder were undertaken on recurrent @entity5 . Short-term results were determined for individual symptoms, and @entity5 recurrence rates were calculated with Kaplan-Meier statistical analyses. RESULTS Subarachnoid dissemination was observed in 11 @entity1 and was related to previous surgery in 9 @entity1 and associated with extensive @entity5 in 2 @entity1 . Gross-total resections (GTR) were achieved in 28 operations (77.7%) and subtotal resections in the remainder. Subtotal resections were restricted to @entity424 (61.5%). Radiotherapy was employed after 6 operations on unencapsulated @entity5 , with 5 of these also demonstrating subarachnoid seeding. Permanent surgical morbidity affected 3 @entity1 who experienced permanent @entity1494 , while 7 @entity1 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 @entity5 capsule. Eight of 9 @entity5 recurrences affected unencapsulated @entity5 , 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 @entity424 , 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 @entity5 . Postoperative radiotherapy tended to prolong the recurrence-free interval for @entity1 with unencapsulated @entity5 . Five @entity1 @entity204 occurred during follow-up, of which 2 @entity204 were @entity5 related and occurred at 216 and 287 months after surgery. CONCLUSION @entity424 are @entity5 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 @entity5 . The role of postoperative radiotherapy remains controversial. Radiotherapy may be considered after incomplete resections of unencapsulated @entity5 and/or for @entity1 with @entity510 .
