Dissemination of primary intracranial ependymoma occurs in 10% of all cases and is difficult to treat, so this may be one of the major reasons for the poor prognosis. Two patients with nodular dissemination of anaplastic ependymoma were treated with repeated stereotactic radiosurgery using the gamma knife (GK), resulting in tumour control over 21 months. GK radiosurgery is a safe and effective treatment option for providing good local control in patients with nodular dissemination of ependymoma.