management of ependymomas george jallo division of pediatric neurosurgery johns hopkins university
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Management of Management of EpendymomasEpendymomas
George Jallo George Jallo
Division of Pediatric NeurosurgeryDivision of Pediatric Neurosurgery
Johns Hopkins UniversityJohns Hopkins University
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Differential Diagnosis Ventricle Differential Diagnosis Ventricle TumorsTumors
EpendymomaEpendymoma AstrocytomaAstrocytoma
SubependymomaSubependymoma EpidermoidEpidermoid
MedulloblastomaMedulloblastoma Choroid Choroid PlexusPlexus tumortumor
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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
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Pathology: EpendymomasPathology: Ependymomas
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ImagingImaging
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Imaging of EpendymomasImaging of Ependymomas
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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
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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.
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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
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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
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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.
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Rogers, L et al. “Is Gross-Total Resection Sufficient for Posterior Fossa Ependymomas?” Journal of Neurosurgery. 2005 Apr; 102(4): 629-636.
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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.
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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.
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ConclusionsConclusions
Surgical resection is goalSurgical resection is goal
Adjuvant radiotherapy is helpful for Adjuvant radiotherapy is helpful for residual disease if not resectableresidual disease if not resectable
Role of chemotherapy still not determinedRole of chemotherapy still not determined