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Neurologic Manifestations of Ependymoma Treatment & Management

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

Medical Care

A multimodality approach that encompasses maximal surgical resection in combination with adjuvant therapy is critical for achieving optimal disease control.[2] Preoperative and perioperative steroids are recommended to help limit edema and alleviate some symptoms.


Surgical Care

Surgery remains the most effective therapy for this tumor. It establishes tissue diagnosis, restores normal cerebrospinal fluid flow, and can be used to attempt total removal of the tumor.

A second-look surgery for unexpected residual lesions that are seen on postoperative imaging in an operable location is encouraged in patients with noninvasive, benign histology.

Permanent cerebrospinal fluid (CSF) diversion with ventriculoperitoneal shunt is rarely required.

Postoperative radiation therapy substantially improves survival. Although not proven, some dose-to-response relationship probably exists.

Newer methods that target only the local tumor bed, such as high fractionation radiotherapy or stereotactic radiosurgery, may permit potential dose reduction as compared with conventional radiotherapy. It provides effective tumor control, which may help limit complications such as cognitive dysfunction, growth delay, and hypothyroidism.

Craniospinal axis radiation is recommended only for patients with radiological or pathological evidence of spinal seeding.

Overall, results of chemotherapy are disappointing.[3] Multidrug combinations using VP-16 etoposide, vincristine, CCNU (lomustine), and cisplatin offer limited benefit in patients with recurrent disease.

Gross total resection (GTR) is associated with the lowest rates of mortality, the best overall survival, and the longest progression-free survival rates. Patients with WHO grade II tumors had better overall survival after GTR plus external-beam radiation therapy (EBRT) and better progression-free survival rates than after GTR alone. Patients with WHO grade III tumors had better overall survival after subtotal resection plus EBRT.[4]



See the list below:

  • Neurosurgeon
  • Neurologist
  • Radiation oncologist
  • Medical oncologist
Contributor Information and Disclosures

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.


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.

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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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