Management of Ependymomas

1
Management of Ependymomas

• George Jallo
• Division of Pediatric Neurosurgery
• Johns Hopkins University

2
Differential Diagnosis Ventricle Tumors

• Ependymoma Astrocytoma
• Subependymoma Epidermoid
• Medulloblastoma Choroid Plexus tumor

3
Posterior Fossa Tumors Clinical Features

• 5-6 of intracranial tumors
• 69 occur in children
• 3rd most common pediatric brain tumor
• 58 present in fourth ventricle

4
Pathology Ependymomas
5
Imaging
6
Imaging of Ependymomas
7
Treatment

• Goal Gross total resection
• Recurrence is common
• Adjuvant therapy
• Radiotherapy beneficial
• Chemotherapy no proven benefit

8
Ependymomas Survival vs. Age
Spagnoli, P. et al. Combined Treatment of Fourth
Ventricular Ependymomas Report of 26 cases.
Surgical Neurology. 2000 54 (1) 19-26.
9
Survival Rate vs. Radical Resection
Subtotal
Spagnoli, P. et al. Combined Treatment of Fourth
Ventricular Ependymomas Report of 26 cases.
Surgical Neurology. 2000 54 (1) 19-26.
10
Microanatomical Location vs. Resection of Tumor
Subtotal
Spagnoli, P. et al. Combined Treatment of Fourth
Ventricular Ependymomas Report of 26 cases.
Surgical Neurology. 2000 54 (1) 19-26.
11
Microanatomical Location vs. Survival Rate
Spagnoli, P. et al. Combined Treatment of Fourth
Ventricular Ependymomas Report of 26 cases.
Surgical Neurology. 2000 54 (1) 19-26.
12
Rogers, L et al. Is Gross-Total Resection
Sufficient for Posterior Fossa Ependymomas?
Journal of Neurosurgery. 2005 Apr 102(4)
629-636.
13
Local Control vs. Treatment
Rogers, L et al. Is Gross-Total Resection
Sufficient for Posterior Fossa Ependymomas?
Journal of Neurosurgery. 2005 Apr 102(4)
629-636.
14
Prognostic Factors
Rogers, L et al. Is Gross-Total Resection
Sufficient for Posterior Fossa Ependymomas?
Journal of Neurosurgery. 2005 Apr 102(4)
629-636.
15
Conclusions

• Surgical resection is goal
• Adjuvant radiotherapy is helpful for residual
  disease if not resectable
• Role of chemotherapy still not determined