Ependymomas are tumors that arise from Ependymal cells,
which make up the thin "lining" of the Ventricular walls of the
Brain cavities (called "Ventricles", where
Cerebrospinal Fluid [CSF] is manufactured) and the Central
Canal of the Spinal Cord. Ependymal cells are the third type of
cell in the "Glial" cell series, the others being
Astrocytes and Oligodendrocytes.
Ependymomas are six times more common in children
compared to adults. The highest age incidence is 1 to 5
years with a second, smaller peak in the
In a manner similar to other "Gliomas", Ependymal Cells can
form a tumor known as an "Ependymoma". These tumors can occur
within the Brain or Spinal Cord. By virtue of the fact
that Ependymomas exist WITHIN THE CEREBROSPIANL FLUID PATHWAYS,
they have the potential to spread ("seed") through the CSF
(Cerebrospinal Fluid) pathway to other areas of the Nervous
The commonest sites of origin are:
- Intracranial: Ependymomas account for only
5-6% of all intracranial Gliomas with 69%
occurring in children (9% of pediatric Brain tumors).
These are usually well circumscribed and "benign" - appearing.
They commonly arise in the Floor of the Fourth
Ventricle (60-70% are infratentorial in region of the 4th
- Spinal: These account for 60% of
Spinal Cord Gliomas,
with 96% occurring in adults.
The symptoms of these intracranial tumors are similar to those of
other intracranial masses. This includes headache (80%),
nausea/vomiting (75%), ataxia (difficulty with balance) or vertigo
(dizziness), and seizures.
These tumors are primarily diagnosed by CT or MRI scans (See
Figures 1 & 2). The diagnosis is then confirmed by microscopic
examination of the tumor.
THE GOAL OF SURGERY IS THE RESECTION (removal) of the
GREATEST AMOUNT OF TUMOR POSSIBLE, WITHOUT CAUSING ADDITIONAL
Our Experience and Long-term Follow-up|
The Neurosurgeons of Neurosurgical Consultants have long
term follow-up experience ranging to 25 years after the successful
complete Microsurgical Resection of 4th Ventricle
Ependymomas without adjunct Radiation Therapy or
Chemotherapy. As an example, one such resection was
accomplished in a 20 year old female (who is now 47 years old) and
subsequently had three (3) successful pregnancies. Despite the fact
that she remains without symptoms and lives in another part of the
USA, we continue to follow her with yearly MRI Scans sent to us from
her home town. We continue to encourage patients with a history
of Ependymomas to adhere to follow-up protocols.
Radiation Therapy may be an important adjunct
particularly in cases where incomplete excision is known to have
occurred, where there is clear evidence of residual or recurrent tumor
or where there are "Drop Metastasis" within the CSF pathways.
Chemotherapy is the third arm of a comprehensive
effort to prolong and maintain a high quality of life.
Chemotherapy has a particularly important role to play in
patients where incomplete excision is known to have occurred,
where there is clear evidence of residual or recurrent tumor or where
there are "Drop Metastasis" within the CSF pathways.
Current Chemotherapy protocols for these tumors have
been upgraded to include some of the relatively non-toxic yet
aggressive agents. One of our
has utilized newer medications such as Temodar (temozolamide),
Avastin (bevacizumab, an anti-angiogenesis agent) and CPT-11,
either alone (or more commonly) in combination or with other drugs,
to produce encouraging results. Additional information regarding these
treatments is available at the
website. Ultimately we continue to hope for the development of
specific gene therapies.
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This page last edited on 2/19