OBJECTIVE: Intramedullary ependymomas account for ∼50 % of all primary tumors in the spinal cord. Though gross total resection has become mainstay, other predictors of survival remain poorly characterized. The present study aims to perform a survival analysis and compare prognostic factors across pediatric, adult and geriatric cohorts. METHODS: The Surveillance, Epidemiology, and End Results database was employed to isolate cases of intramedullary ependymomas from 2000 to 2021. Cases were grouped based on age: 0-19 years=pediatric, 20-64 years=adult, 65 + years=geriatric. Kaplan Meier followed by multivariate cox regression analyses were used to identify survival trends. Univariate comparison analyses compared age cohorts. RESULTS: 2045 cases were included. Geriatric patients demonstrate increased risk of mortality (pediatric vs geriatric: HR=0.23, CI [0.13-0.39], p <
0.001
adult vs geriatric: HR=0.18, CI [0.15-0.23], p <
0.001). Compared to adult patients (92.7 %), geriatric patients (85.2 %) underwent significantly less surgery (p <
0.001). Sex did not influence pediatric or geriatric survival nor did surgery statistically impact pediatric survival, but otherwise surgery not performed, male patients and grade III tumors significantly worsened overall and age-specific survival. Surgery performed in a pediatric patient led to a longer mean survival of 19.8 months, which is clinically relevant despite not meeting statistical significance. Year of diagnosis did not impact overall (p = 0.79) nor age-specific survival (pediatric: p = 0.98, adult: p = 0.91, geriatric: p = 0.11). CONCLUSIONS: Geriatric patients suffer from worse survival than those of younger age. Surgery decreases mortality, yet less geriatric patients are receiving surgical resection. No significant survival gains have been made over the last two decades among any age. Further study is needed to optimize medical management to compliment surgical resection and surgery should be considered more often in geriatric patients to improve survival.