title: The history of ependymoma management.
abstract: BACKGROUND
  The ependymomas are relatively not a common tumor. However, most clinicians agree that the radical removal of the tumor is the most important prognostic factor.
  Tumor removal was not sufficient before the era of magnetic resonance imaging (MRI) and resulted in a considerable operative morbidity and mortality. As the microneurosurgical techniques and microsurgical anatomy become popular and the MRI provide more detailed anatomical information preoperatively, radical removal of this complex and complicated tumor can be more feasible. In childhood ependymoma, the treatment-related morbidity and mortality can be the special issues, which can modify the policy of management safe tumor removal and minimal adjuvant treatment, which are extremely important.
  Radiation treatment has been the option for disseminated disease and residual tumor. With the advancement of detailed MR anatomical information, safer and more delicate radiation becomes possible with newer radiation modalities, three-dimensional conformal radiotherapy, intensity modulating radiotherapy, and tomotherapy.
  Although many clinicians believe that the ependymomas are inheritably chemoresistant, the new targets for the treatment are under investigation or clinically tried. Also, the genetic alterations of ependymoma are developing and might be a promising target.
  
  
  CONCLUSIONS
  The surgical techniques and assistant modalities for tumor removal are still advancing. So, the outcome of ependymoma is still improving. Unfortunately, newer treatment modalities, such as new chemotherapeutic agent and gene modification agent, are still not promising. The history of ependymoma management is still in progress.
authors.affiliation: Department of Pediatric Neurosurgery, Severance Children's Hospital, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyu-Won
authors.initials: KW
authors.lastname: Shim
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
authors.forename: Joong-Uhn
authors.initials: JU
authors.lastname: Choi
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D002648:Child; D004358:Drug Therapy / Q000401:mortality; D004806:Ependymoma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D019635:Neurosurgical Procedures / Q000401:mortality; D011379:Prognosis; D011878:Radiotherapy / Q000401:mortality; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy