Intracranial ependymoma is an infrequent tumor in children, accounting
for less than 15% of all brain tumors and less than 5% of all cancers
seen in the pediatric population. Three of every four cases develop u
nder the tentorium. A small number of cases confined to the spine have
been reported in children. Nearly 50% of patients are younger than fo
ur years at diagnosis. Inaugural symptoms are usually abrupt in onset
and lacking in specificity, being dominated by vomiting and behavioral
disorders. Older children tend to present with more specific manifest
ations such as headache, seizures, motor disorders, and cerebellar dys
function. The diagnosis rests on imaging studies and on histologic exa
mination of the operative specimen. Some patients require placement of
a ventricular shunt prior to surgical removal of the tumor. The progn
osis remains poor, with a five-year survival rate of 16% to 67%. Altho
ugh few predictive factors are agreed on, a poor prognosis seems more
common in very young patients, when excision is incomplete, when recur
rences develop, and/or when the tumor site is not treated by radiation
. The authors' experience with six children is reported.