gms | German Medical Science

Objective: Filum terminale ependymomas represent about 40% of spinal ependymomas and about 10% of the extraosseous spinal tumors of adults. Although benign, they tend to be more biologically aggressive in young people. Clinical features of these lesions are: a gradual and insidious onset; back pain followed at variable intervals by asymmetrical radiation to both legs; worsening pain on recumbency. Rare cases of acute onset due to haemorrhage have been described. Urinary urgency and perineal anaesthesia represent late manifestations of the disease.

Methods: In retrospect we reviewed 35 consecutive patients with filum terminale ependymomas operated on between 1980 and 2004.

Results: We will discuss the management of these patient based on statistical analysis of our series, on the literature, taking into consideration the role of both surgery and radiotherapy.

Conclusions: Gross total en bloc resection should be the treatment of choice for small and moderate tumors. In fact, internal decompression can increase the risk of CSF dissemination. Recurrences after successful en bloc resection are rare. Large ependymomas of the filum terminale, however, can be difficult to resect surgically. Typically, they are present for many years and are associated with a risk of being disseminated via the CSF. These unencapsulated, pliable neoplasms can insinuate among the nerve roots and within the arachnoid sheaths of the cauda equina, compartmentalized by innumerable arachnoid septa. In such cases, tumor removal is necessarily piecemeal and almost always subtotal. Even when piecemeal gross total removal is achieved, a recurrence rate of at least 20% can be anticipated.