Ependymoma Surgery: Spinal, Myxopapillary and Brain Ependymoma

What Is Ependymoma Surgery?

Ependymoma surgery removes a tumor that grows from the cells lining the brain's fluid spaces or the center of the spinal cord. For most people, it is the first treatment, and complete removal is the single strongest factor for long-term control.

First, in adults, most ependymomas sit in the spine. In children, by contrast, most grow inside the head, often near the fourth ventricle.

Many of these tumors have a clear border. So a careful operation can often take out the whole tumor while it protects the nerves around it.

At a Glance

• Who it helpsAdults and children with an ependymoma of the spinal cord, the lower spine or the brain
• Main goalRemove the whole tumor safely and confirm its exact type
• Common typesSpinal ependymoma, myxopapillary ependymoma, subependymoma, brain ependymoma
• After surgeryMany people need no further treatment; some have focused radiotherapy
• Hospital stayOften about five to ten days, longer after a large operation
• Follow-upRegular brain and spine MRI for many years

Where Are You in Your Decision?

Pick the line that sounds most like you. Each one then opens the matching part of this guide.

1. 01My MRI report says ependymoma. Which type is it?Four main types and the usual plan for each→
2. 02Do I really need surgery, or can radiation do?All treatment options side by side→
3. 03My tumor is in the spinal cord or the lower spineHow spinal and myxopapillary surgery works→
4. 04My tumor is in the brainFourth ventricle and upper brain ependymoma→
5. 05I want to know about risks, recovery and recurrenceWarning signs, timeline and MRI schedule→
6. 06I am planning surgery from abroadLength of stay, flights and follow-up at home→

Types of Ependymoma and What They Mean for Surgery

The type and location of the tumor shape the whole plan. In fact, the NCI notes that location and molecular features predict the outlook better than grade alone.

Questions at this stage

When to See a Doctor About Ependymoma Symptoms

Slow symptoms deserve a prompt appointment and an MRI. Sudden loss of strength or of bladder control, however, needs an emergency department the same day.

Why Speed Matters

In fact, nerve function before surgery strongly predicts function after it. So a weakness that has just begun has a better chance to recover than one that has lasted for months.

Ependymoma Treatment: Surgery, Radiation and Other Options

The NCI lists surgery as the first treatment for an ependymoma whenever it is possible. Radiation, radiosurgery and medicine then play a supporting role.

Why Complete Removal Matters Most

First, a tumor that comes out whole is far less likely to return. For this reason, Prof. Albayrak aims for maximal safe removal, which means taking all the tumor that he can take without new damage.

Also, surgery gives tissue for the final diagnosis. Today, the pathology report should name the molecular subtype as well as the grade, because that subtype guides any further treatment.

How Spinal Ependymoma Surgery Works

Spinal ependymoma surgery takes place under general anesthesia, with the patient face down. It often lasts several hours, since the surgeon works slowly between nerve fibers.

1. Opening the spine: first, the surgeon lifts the back muscles and removes or hinges the bony arches over the tumor.
2. Watching the nerves: then nerve monitoring checks the pathways for movement and feeling throughout the operation.
3. Reaching the tumor: after the dura opens, a short cut along the midline of the cord exposes the tumor.
4. Removing it: under the microscope, the surgeon finds the border and then separates the tumor from the cord.
5. Closing: the dura closes watertight, and the bony arches also go back where the plan allows.

Prof. Albayrak uses microsurgery and neuronavigation for these tumors. His 2004 first-author review also describes how imaging during surgery can guide tumor removal.

Myxopapillary Ependymoma Surgery

Here the tumor hangs among the nerve roots of the cauda equina. So the surgeon frees it from the roots, then cuts the filum thread above and below it. Then the tumor comes out in one piece.

If the capsule breaks, however, tumor cells can spread through the spinal fluid. For this reason, a large tumor that has broken open often receives radiotherapy afterward.

Tests Before and After Surgery

Before surgery, an MRI of the whole brain and spine looks for spread along the fluid pathways. After surgery, Prof. Albayrak often checks a spinal fluid sample, taken at least two weeks later, for tumor cells.

For other tumors of the spine, see our guide to spinal cord and spine tumors.

Brain Ependymoma Surgery

For a tumor near the fourth ventricle, the surgeon goes in through the back of the head, below the cerebellum. In the upper brain, a craniotomy above the tumor gives the shortest safe route.

Tumors of the fourth ventricle often reach toward the brainstem and the nerves for swallowing and eye movement. So Prof. Albayrak uses nerve monitoring to protect these nerves. He also uses microsurgery and fluorescence-guided techniques to see the tumor border.

When the Fluid Pathway Gets Blocked

Also, a blocked fourth ventricle can raise pressure in the head. In that case, he first restores fluid flow with an endoscopic third ventriculostomy or a shunt; our hydrocephalus treatment guide explains both.

For the operation itself, see our guide to cerebellar tumor surgery. Our brain tumors page covers other tumor types.

Ependymoma Surgery Risks and Success Rate

The main risks come from the delicate tissue around the tumor. Most effects are temporary, but some can last.

• New numbness or weakness: common for a few weeks after spinal surgery; most of it improves with rehabilitation.
• Bladder, bowel or sexual changes: also possible after lower spine surgery; they often ease over months.
• Spinal fluid leak: a clear wound discharge or headache when you stand up; see our guide to CSF leak repair.
• Swallowing or eye movement problems: after fourth ventricle surgery, usually temporary.
• Infection, bleeding and blood clots: uncommon, as with other major operations.
• Spinal deformity: mainly in children and after surgery over many levels.

What the Numbers Say

The NCI reports a five-year relative survival of about 88 percent for ependymoma overall. However, grade, type, location, age and the amount of tumor left all change that figure. So ask your surgeon to explain your own situation.

Ependymoma Surgery Recovery Time

Most people stand up within a day or two and leave the hospital within about a week to ten days. After that, recovery of nerve function often continues for several months.

Follow-Up MRI and Recurrence

Ependymoma can return, most often within the first two to five years and at the original site. So Prof. Albayrak's usual plan is an MRI of the brain and spine every three to four months for two years. After that, scans come every six months until year five, then once a year.

Also, a recurrence found early is often small. Then a second operation, radiosurgery or radiotherapy can usually treat it.

Ependymoma in Children

Children, however, more often have brain ependymomas, and their plan involves a pediatric oncology team. Read our guides to brain tumors in children and spinal cord tumors in children.

Coming to Istanbul from the US, Canada, the UK or Europe

Ependymoma surgery rarely counts as an emergency, so it suits a trip you arrange ahead. Sudden weakness or loss of bladder control, however, calls for care at home first.

How Long to Stay in Istanbul

First, count the consultation, any new MRI and about a week to ten days in hospital. Then add a few days until your surgeon clears you to fly. So many people stay about two to three weeks in total.

When You Can Fly Home

The UK CAA advises waiting about seven days after surgery inside the skull. For spine surgery, it sets no fixed period, so your surgeon decides at the check-up.

Also, the US CDC warns that flying soon after surgery raises the risk of blood clots. So walk in the aisle and drink water on the flight.

Follow-Up at Home

Before you leave, ask for the operation report, the discharge summary and copies of your scans. The final pathology report, with its molecular subtype, follows by email. If you need radiotherapy, your local oncology team can then plan it near home.

For insurance and Medicare, see planning surgery in Turkey from the US. For NHS rules and travel insurance, see planning from the UK. From Canada, check with your provincial health plan and private insurer before you book.

Your Ependymoma Surgeon in Istanbul

Prof. Dr. Serdar Baki Albayrak

Neurosurgeon · Full Professor of Neurosurgery

Prof. Albayrak removes ependymomas of the spinal cord, the lower spine and the brain with microsurgery and nerve monitoring. He plans each operation around the tumor type and your nerve function.

After medical school at Marmara University, he trained in neurosurgery at Istanbul University. Clinical fellowships at the University of Helsinki and Harvard Medical School followed.

27+Years

5,000+Operations

64Countries

33Publications

Figures from Prof. Albayrak's professional profile, September 2026. See his full publication list.

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