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Neurologic Manifestations of Ependymoma Follow-up

  • Author: Subrata Ghosh, MD, MBBS, MS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
 
Updated: Mar 19, 2015
 

Further Outpatient Care

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  • Radiation therapy
  • Chemotherapy
  • Serial neuroimaging (MRI)
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Further Inpatient Care

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  • Admit the patient for repeat surgery.
  • Admit the patient for treatment of complications from surgery, radiotherapy, or chemotherapy.
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Complications

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  • Hydrocephalus
  • Paralysis
  • Cranial nerve palsy
  • Meningitis
  • Bone marrow suppression
  • Cognitive dysfunction
  • Growth and developmental delay
  • Hypothyroidism
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Prognosis

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  • Gross total resection is the most important determinant of outcome, with progression-free survival rates of 70-80% after 5 years, compared to 35% for incomplete resection.
  • Postoperative radiation therapy improves survival, whereas results of chemotherapy are disappointing.[3]
  • Age also strongly correlates with outcome. Usually, the younger the patient, the worse the prognosis.
  • In addition to age, supratentorial tumor location is associated with a worse prognosis in adult ependymoma patients. Supratentorial location was also correlated with shorter progression-free survival than infratentorial location in a multicenter retrospective analysis.[5]
  • Studies in which the current WHO classification criteria were applied reported the relationship between histological grade and outcome. Biomolecular studies have identified that gain of 1q25 and epidermal growth factor receptor (EGFR) overexpression correlate to poor prognosis, whereas low expression of nucleolin correlated with a favorable outcome.[6]
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Patient Education

Refer the patient for psychosocial counseling.

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Contributor Information and Disclosures
Author

Subrata Ghosh, MD, MBBS, MS Staff Physician, Division of Neurosurgery, St. Luke's Episcopal Hospital, Texas Medical Center, Houston; Assistant Professor of Neurosurgery, Baylor College of Medicine

Subrata Ghosh, MD, MBBS, MS is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, Texas Medical Association, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Draga Jichici, MD, FRCP, FAHA Associate Clinical Professor, Department of Neurology and Critical Care Medicine, McMaster University School of Medicine, Canada

Draga Jichici, MD, FRCP, FAHA is a member of the following medical societies: American Academy of Neurology, Royal College of Physicians and Surgeons of Canada, Canadian Medical Protective Association, Canadian Medical Protective Association, Neurocritical Care Society, Canadian Critical Care Society, Canadian Critical Care Society, Canadian Neurocritical Care Society, Canadian Neurological Sciences Federation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jorge C Kattah, MD Head, Associate Program Director, Professor, Department of Neurology, University of Illinois College of Medicine at Peoria

Jorge C Kattah, MD is a member of the following medical societies: American Academy of Neurology, American Neurological Association, New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Stephen A Berman, MD, PhD, MBA Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Rodrigo O Kuljis, MD Esther Lichtenstein Professor of Psychiatry and Neurology, Director, Division of Cognitive and Behavioral Neurology, Department of Neurology, University of Miami School of Medicine

Rodrigo O Kuljis, MD is a member of the following medical societies: American Academy of Neurology, Society for Neuroscience

Disclosure: Nothing to disclose.

References
  1. Villano JL, Parker CK, Dolecek TA. Descriptive epidemiology of ependymal tumours in the United States. Br J Cancer. June 2013. 108(11):2367-71. [Medline].

  2. Kim JH, Huang Y, Griffin AS, Rajappa P, Greenfield JP. Ependymoma in children: molecular considerations and therapeutic insights. Clin Trans Oncol. April 2013. [Medline].

  3. Moynihan TJ. Ependymal tumors. Curr Treat Options Oncol. 2003 Dec. 4(6):517-23. [Medline].

  4. Cage TA, Clark AJ, Aranda D, et al. A systematic review of treatment outcomes in pediatric patients with intracranial ependymomas. J Neurosurg Pediatr. 2013 Jun. 11(6):673-81. [Medline].

  5. Dützmann S, Schatlo B, Lobrinus A, et al. A multi-center retrospective analysis of treatment effects and quality of life in adult patients with cranial ependymomas. J Neurooncol. 2013 Jun 29. [Medline].

  6. Massimino M, Buttarelli FR, Antonelli M, Gandola L, Modena P, Giangaspero F. Intracranial ependymoma: factors affecting outcome. Future Oncology. 2009 March. 5(2):207-16. [Medline]. [Full Text].

  7. Bhattacharjee MB, Armstrong DD, Vogel H, Cooley LD. Cytogenetic analysis of 120 primary pediatric brain tumors and literature review. Cancer Genet Cytogenet. 1997 Aug. 97(1):39-53. [Medline].

  8. Bigner SH, McLendon RE, Fuchs H, et al. Chromosomal characteristics of childhood brain tumors. Cancer Genet Cytogenet. 1997 Sep. 97(2):125-34. [Medline].

  9. Ernestus RI, Schroder R, Stutzer H, Klug N. The clinical and prognostic relevance of grading in intracranial ependymomas. Br J Neurosurg. 1997 Oct. 11(5):421-8. [Medline].

  10. Graham DI, Lantos PL, eds. Greenfield's Neuropathology. 6th ed. Arnold Press; 1997. 636-44.

  11. Kaye AH, Laws E Jr, eds. Brain Tumors: An Encyclopedic Approach. First ed. Churchill Livingstone; 1997. 493-504.

  12. Kleihues P et al. Pathology & Genetics. Tumors of the Nervous System. International Agency for Research on Cancer (IARC)/World Health Organization. 1997. 96-109.

  13. Kleihues P, Burger PC, Scheithauer BW. The new WHO classification of brain tumours. Brain Pathol. 1993 Jul. 3(3):255-68. [Medline].

  14. Kun LE. Brain tumors. Challenges and directions. Pediatr Clin North Am. 1997 Aug. 44(4):907-17. [Medline].

  15. McLaughlin MP, Marcus RB, Buatti JM, et al. Ependymoma: results, prognostic factors and treatment recommendations. Int J Radiat Oncol Biol Phys. 1998 Mar 1. 40(4):845-50. [Medline].

  16. Nazar GB, Hoffman HJ, Becker LE, et al. Infratentorial ependymomas in childhood: prognostic factors and treatment. J Neurosurg. 1990 Mar. 72(3):408-17. [Medline].

  17. Osborn AG. Diagnostic Neuroradiology: A Text and Atlas. First ed. Mosby; 1994. 566-70.

  18. Russell DS, et al. Pathology of Tumors of the Nervous System. 4th ed. Arnold Press; 1977. 203-26.

  19. Chamberlain MC, Chang E, Maravilla KR. Lumbar spine neuroarthropathy (Charcot joint) caused by a myxopapillary ependymoma. J Neurooncol. 2014 Apr. 117(2):375-6. [Medline].

  20. Wang H, Zhang S, Rehman SK, Zhang Z, Li W, Makki MS, et al. Clinicopathological features of myxopapillary ependymoma. J Clin Neurosci. 2014 Apr. 21(4):569-73. [Medline].

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CT scan without contrast, axial view, demonstrates mixed but predominantly hyperdense tumor in the posterior fossa with severe obstructive hydrocephalus.
CT scan with contrast, axial view shows moderately intense contrast enhancement (compare with the previous image).
MRI, T2-weighted image, axial view, showing mixed (isodensity and hyperdensity) heterogenous nature of the tumor with some peritumoral edema.
MRI, T1-weighted image, without contrast, sagittal view, showing the posterior fossa location, mixed (hypodensity and isodensity) signal intensity and tending to grow out of the fourth ventricle.
 
 
 
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