Surgical excision remains the treatment of choice for symptomatic ependymomas, and the extent of resection plays a crucial role in prognosis.2 Gross total resection (GTR) is associated with favorable outcomes, with recurrence being relatively rare but possible, particularly in Grade II tumors.1 Recurrence is more common in tumors with high Ki-67 proliferation indices, which may necessitate further surgery. Here, MKI67 is linked to ependymoma.