title: Paediatric intracranial anaplastic ependymoma: the role of multiple surgical resections for disease relapse in maintaining quality of life and prolonged survival.
abstract: BACKGROUND
  Ependymoma is the third most common intracranial glioma in children. The treatment of choice for these tumours remains gross total resection followed by radiotherapy. There are two principal histological subtypes, namely classic (∼70%) and anaplastic (∼30%) ependymoma.
  
  
  METHODS
  We present the case of a 12-year-old girl with an anaplastic ependymoma of the left temporal lobe. She underwent initial image-guided resection following biopsy. A postoperative MRI showed a macroscopic resection. She subsequently relapsed and indeed had 11 local and distant relapses managed by 12 separate craniotomies and tumour resection, 4 courses of radiotherapy and chemotherapy.
  
  
  CONCLUSIONS
  For patients with multiple relapses, surgery should be considered primarily to re-resect any symptomatic lesion. This case demonstrates that multiple tumour resections can be undertaken with limited morbidity for the patient and with maintenance of quality of life. Repeated focal irradiation can also be used to control the disease with limited morbidity.
authors: Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK.
authors: William John
authors: WJ
authors: Kitchen
authors: Barry
authors: B
authors: Pizer
authors: Benedetta
authors: B
authors: Pettorini
authors: David
authors: D
authors: Husband
authors: Conor
authors: C
authors: Mallucci
authors: Michael D
authors: MD
authors: Jenkinson
mesh_terms: D001932:Brain Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002648:Child; D003399:Craniotomy / Q000379:methods*; D004806:Ependymoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis / Q000473:pathology / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D011788:Quality of Life; D012086:Reoperation / Q000379:methods*; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome