Supratentorial ependymoma in children.

The clinical and pathological characteristics of supratentorial ependymomas (STE) in children are not well identified in the literature, because most series deal with ependymomas regardless of their location or the age of the patient. As a result, the pathological description of the disorder is still debated. We therefore reviewed our cases of children operated for STE and compared them with cases of infratentorial ependymomas (ITE) to provide a better characterization of STE and suggest guidelines for treatment. From 1985 to 1999, we operated 18 children for STE, almost half of which developed with no connection to the ventricular system. Intraoperative bleeding and infiltration of the basal ganglia prevented total removal in 4 cases and were the main causes of operative mortality and morbidity. The 5-year overall survival and recurrence-free survival rates were 54 and 37%, respectively, and were highly affected by the extent of resection, but not by histological grade. Because of the high recurrence rate, we recommend systematic postoperative irradiation limited to the tumor site for all high-grade tumors in older children, and reoperation after subtotal removal and for recurrences.