Management of Management of EpendymomasEpendymomas

George Jallo George Jallo Division of Pediatric NeurosurgeryDivision of Pediatric Neurosurgery

Johns Hopkins UniversityJohns Hopkins University

Differential Diagnosis Ventricle Differential Diagnosis Ventricle TumorsTumors

EpendymomaEpendymoma AstrocytomaAstrocytoma

SubependymomaSubependymoma EpidermoidEpidermoid

MedulloblastomaMedulloblastoma Choroid Choroid PlexusPlexus tumortumor

Posterior Fossa Tumors: Clinical Posterior Fossa Tumors: Clinical FeaturesFeatures

5-6% of intracranial tumors5-6% of intracranial tumors

69% occur in children69% occur in children

33rdrd most common pediatric brain tumor most common pediatric brain tumor

58% present in fourth ventricle58% present in fourth ventricle

Pathology: EpendymomasPathology: Ependymomas

ImagingImaging

Imaging of EpendymomasImaging of Ependymomas

TreatmentTreatment

Goal: Gross total resectionGoal: Gross total resection

Recurrence is commonRecurrence is common

Adjuvant therapyAdjuvant therapy– Radiotherapy beneficialRadiotherapy beneficial– Chemotherapy: no proven benefitChemotherapy: no proven benefit

Ependymomas: Survival vs. AgeEpendymomas: Survival vs. Age

Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas: Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26.

Survival Rate vs. Radical ResectionSurvival Rate vs. Radical Resection

Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas: Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26.

Subtotal

Microanatomical Location vs. Microanatomical Location vs. Resection of TumorResection of Tumor

Spagnoli, P. et al. “Combined Treatment of Fourth Ventricular Ependymomas: Report of 26 cases.” Surgical Neurology. 2000; 54 (1): 19-26.

Subtotal

Microanatomical Location vs. Survival RateMicroanatomical 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.

Rogers, L et al. “Is Gross-Total Resection Sufficient for Posterior Fossa Ependymomas?” Journal of Neurosurgery. 2005 Apr; 102(4): 629-636.

Local Control vs. TreatmentLocal 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.

Prognostic FactorsPrognostic Factors

Rogers, L et al. “Is Gross-Total Resection Sufficient for Posterior Fossa Ependymomas?” Journal of Neurosurgery. 2005 Apr; 102(4): 629-636.

ConclusionsConclusions

Surgical resection is goalSurgical resection is goalAdjuvant radiotherapy is helpful for Adjuvant radiotherapy is helpful for residual disease if not resectableresidual disease if not resectableRole of chemotherapy still not determinedRole of chemotherapy still not determined