Finally, some tumors especially ones located in the lower spine down may present with back pain. This pain may also radiate into the legs. The role of surgery for filum terminale ependymomas depends on the size of the tumor and its relationship to the surrounding roots of the cauda equina. Gross total resection should be attempted when possible. This can usually be accomplished with small and moderate-sized tumors that remain well circumscribed within the fibrous coverings of the filum terminale and are easily separable from the cauda equina nerve roots.
Large tumors can present significant problems for surgical resection.
These tumors have been present for many years and present a risk for spread through the cerebrospinal fluid. Biologically aggressive tumors, which are more common in younger patients, demonstrate early tumor recurrence and can be treated with radiation therapy. If a significant amount of tumor is left behind post-operative radiation therapy is given as a primary adjunctive treatment. These are tumors that arise from ependymal cells within the substance of the spinal cord. Ependymomas are the most common intramedullary tumor in adults.