Ependymomas are the most frequent spinal cord tumors in adult patients. Although magnetic resonance imaging can be a highly accurate diagnostic tool, it does not always provide accurate differentiation between ependymomas and astrocytomas. This is why the authors recommend surgical resection and histological evaluation in all intraspinal cord tumors. It cannot be said that a tumor is unresectable without first attempting to remove it. Complete removal should be accomplished whenever possible, and patients should undergo operation before they become neurologically impaired. Quality of life depends on preoperative neurological status. Postoperative radiotherapy should be avoided in all low-grade ependymomas even after partial removal. Radiotherapy may be used to treat anaplastic ependymomas, which are quite rare in the spinal cord. Patients with low-grade ependymomas must be followed for years and undergo reoperation if necessary. In our experience treating 93 spinal cord ependymomas, complete removal was achieved in 86 patients and only one patient underwent reoperation 18 years later for tumor recurrence. The gold standard in treatment protocol is gross-total resection without adjunctive radiation therapy. Good long-term outcomes have been achieved by using this strategy.